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目的:研究连续性肾脏替代治疗(CRRT)过程中多器官功能障碍综合征(MODS)患者血清对体外培养血管内皮细胞分泌组织因子(TF)及纤溶酶原激活物抑制剂-1(PAI-1)的影响。方法:16例MODS患者随机分为两组,一组给予无肝素CRRT治疗,另一组给予普通肝素抗凝的CRRT治疗。观察患者行CRRT治疗8h过程中的变化,在治疗0min、15min、1h、2h、8h时分别留取血样5mL。ELISA法检测患者血清TNF-α、IL-1β水平。观察CRRT治疗不同时间点血清对内皮细胞分泌TF及PAI-1蛋白水平的影响,RT-PCR法检测TF及PAI-1mRNA水平的表达。结果:MODS患者血清可明显增加体外培养血管内皮细胞TF及PAI-1的分泌,经CRRT治疗后,患者血清对内皮细胞分泌TF及PAI-1的影响逐步减小。无肝素组内皮细胞分泌TF及PAI-1蛋白水平与相应干预血清TNFα水平均呈正相关,相关系数分别为0.902,0.939(P<0.05);肝素组内皮细胞分泌TF及PAI-1水平与相应干预血清TNFα水平均无相关性(P>0.05)。结论:MODS患者血清促进内皮细胞分泌TF及PAI-1,内皮细胞功能明显异常,可能与炎症介质有关。CRRT治疗可清除血液中激活/损伤内皮细胞的成分,改善患者内皮细胞功能。
OBJECTIVE: To investigate the effect of sera from patients with multiple organ dysfunction syndrome (MODS) on the secretion of tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1) in vascular endothelial cells during continuous renal replacement therapy (CRRT) 1) influence. Methods: Sixteen patients with MODS were randomly divided into two groups. One group received no heparin CRRT and the other group received unfractionated heparin anticoagulant therapy. The changes of patients treated with CRRT for 8h were observed. Blood samples of 5mL were collected at 0min, 15min, 1h, 2h, 8h respectively. Serum levels of TNF-α and IL-1β were detected by ELISA. The effect of serum of CRRT treatment on the secretion of TF and PAI-1 protein in endothelial cells was observed at different time points. The expression of TF and PAI-1 mRNA was detected by RT-PCR. Results: The serum of patients with MODS significantly increased the secretion of TF and PAI-1 in cultured vascular endothelial cells. After CRRT treatment, the effect of serum on the secretion of TF and PAI-1 by endothelial cells was gradually reduced. The levels of TF and PAI-1 secreted by endothelial cells in the non-heparin group were positively correlated with the levels of TNFα in the corresponding interventions, and the correlation coefficients were 0.902 and 0.939, respectively (P <0.05). The levels of TF and PAI-1 secreted by endothelial cells in heparin group were significantly lower than those in the corresponding intervention Serum TNFα levels were not related (P> 0.05). Conclusion: Serum of patients with MODS can promote the secretion of TF and PAI-1 by endothelial cells. The function of endothelial cells is obviously abnormal, which may be related to inflammatory mediators. CRRT treatment can clear the blood activation / damage to the composition of endothelial cells, improve endothelial cell function in patients.