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随着对脓毒症发病机制的深入研究,免疫功能改变、免疫动态平衡失调在脓毒症发病中的作用逐渐受到人们的重视。免疫调理治疗被认为是脓毒症治疗的一个希望所在。连续性血液净化(CBP)治疗能通过多种方式调节脓毒症的免疫功能,对改善脓毒症的预后有积极的作用。其可能的机制有:①通过滤过和吸附的机制,清除血浆中存在的可溶性炎性介质,减轻炎症介质对免疫细胞功能的直接抑制;阻断Th_1向Th_2的漂移;减轻淋巴细胞异常凋亡。②清除血中除炎症介质以外的其他毒性物质及某些致病因子。③抑制炎症系统与凝血系统的相互作用,阻断炎症级联。④纠正脓毒症患者内环境紊乱,改善组织氧合和心肺功能,重建机体免疫系统内稳状态等。因此,CBP的免疫调节作用在脓毒症的治疗中具有十分重要的研究和应用价值。
With the in-depth study of the pathogenesis of sepsis, immune function changes, immune homeostasis in the pathogenesis of sepsis has gradually attracted the attention of people. Immunotherapy is considered a hope for the treatment of sepsis. Continuous blood purification (CBP) therapy can modulate the immune function of sepsis in a variety of ways and has a positive effect on improving the prognosis of sepsis. The possible mechanisms are as follows: (1) to remove the soluble inflammatory mediators existing in the plasma by filtration and adsorption mechanism, to reduce the direct inhibition of inflammatory cell function on immune cells, to block the migration of Th1 to Th2 and to reduce the abnormal apoptosis of lymphocytes . ② remove blood other than inflammatory mediators in addition to other toxic substances and certain risk factors. ③ inhibition of the inflammatory system and the coagulation system interaction, blocking the inflammation cascade. ④ correct sepsis in patients with environmental disorders, improve tissue oxygenation and cardiopulmonary function, rebuild the body’s immune system, such as the steady state. Therefore, the immunomodulatory effects of CBP in the treatment of sepsis has very important research and application value.