【摘要】 目的 研究重症肺炎患者采用连续高容量血液净化后患者的免疫功能变化。方法 选择2019年1—12月福建省龙岩市第二医院重症加强护理病房（ICU）科室收治的30例重症肺炎患者为研究对象，根据不同治疗方式分为对照组（n=15）和试验组（n=15），对照组行基础治疗，试验组行连续高容量血液净化，对比两组的炎症指标、免疫功能指标及T淋巴细胞亚群水平。结果 试验组患者的C-反应蛋白（CRP）、降钙素原（PCT）均低于对照组，差异有统计学意义（P <0.05）。试验组患者的白细胞介素6(IL-6)、肿瘤坏死因子α（TNF-α）均低于对照组，差异有统计学意义（P <0.05）。试验组患者的辅助T淋巴细胞（CD3~+）、诱导T淋巴细胞（CD4~+）均高于对照组，差异有统计学意义（P <0.05）。试验组患者的细胞毒T淋巴细胞（CD8~+）低于对照组，差异有统计学意义（P <0.05）。试验组患者免疫损害的大小（CD4~+/CD8~+）高于对照组，差异有统计学意义（P <0.05）。结论 重症肺炎患者应用连续高容量血液净化治疗效果显著，能够清除免疫抑制因子、炎症介质等，使促炎、抗炎细胞因子比例达到一种新平衡，还可明确HVHF改善重症肺炎患者体内的免疫抑制状态、重建机体免疫内稳状态情况，改善重症肺炎患者的免疫功能，促进重症肺炎患者的早期恢复，具有临床应用推广价值。更多还原

【Abstract】 Objective To study the effect of high-volume continuous blood purification on the changes of immune function in patients with severe pneumonia. Methods A total of 30 patients with severe pneumonia who were admitted to the intensive care unit(ICU) of the Second Hospital of Longyan City in Fujian Province for clinical treatment from January to December 2019 were selected as study subjects,They were divided into control group(n=15)and experimental group(n=15) according to different treatment methods. The control group received basic treatment, while the experimental group received high-volume continuous blood purification. The inflammatory indicators,indicators of immune function and the levels of T-lymphocyte subpopulation were compared between the two groups. Results The levels of C-reactive protein(CRP) and procalcitonin(PCT) in the experimental group were lower than those in the control group, with statistically significant differences(P < 0.05). The levels of interleukin 6(IL-6) and tumor necrosis factor-α(TNF-α) in the experimental group were lower than those in the control group, with statistically significant differences(P < 0.05). The counts of helper T lymphocytes(CD3+) and inducer T lymphocytes(CD4~+)in the experimental group were higher than those in the control group, with statistically significant differences(P < 0.05). The count of cytotoxic T lymphocytes(CD8~+) in the experimental group was lower than that in the control group, with statistically significant differences(P < 0.05). The degree of immune damage(CD4~+/CD8~+) in the experimental group was higher than that in the control group, with statistically significant difference(P < 0.05). Conclusion In the treatment of patients with severe pneumonia, highvolume continuous blood purification therapy can effectively remove immunosuppressive factors and inflammatory mediators, so that the ratio of pro-inflammatory and anti-inflammatory cytokines can reach a new balance. Meanwhile, it can also clarify the effect of high volume hemofiltration(HVHF) in improving the immunosuppressive state in patients with severe pneumonia and reconstructing the homeostasis of the immune system, as well as improving the immune function and promote the early rehabilitation of patients with severe pneumonia. Therefore, it is worthy of clinical application and promotion.更多还原