小剂量糖皮质激素治疗毛细血管渗漏综合征的疗效观察

Therapeutic effect of small dose of glucocorticoid on patients with capillary leak syndrome

关键词:  小剂量糖皮质激素  毛细血管渗漏综合征  NF-κB  细胞因子

Key words:  small dose of glucocorticoid  capillary leak syndrome  NF-κB  Cytokines

摘要:

目的　观察小剂量糖皮质激素治疗毛细血管渗漏综合征（CLS）的临床疗效。方法　选择2013年5月至2015年7月间收治的32例毛细血管渗漏综合征患者作为研究对象，将其分为对照组和激素治疗组，每组16例。对照组给予液体复苏等常规治疗，激素治疗组以此为基础加用小剂量糖皮质激素治疗，观察并监测两组患者全身水肿情况和每日尿量，记录治疗前及治疗7 d后的中心静脉压(CVP)、平均动脉压（MAP）及血清白蛋白(ALB)。采用酶联免疫吸附法测定患者血清相关细胞因子的浓度。结果　治疗7 d后，与对照组相比，激素治疗组患者的病死率显著降低，日均尿量明显增多，水肿明显好转，差异均有统计学意义（P<0.05）。此外，与对照组相比，激素治疗组患者CVP、ALB水平都有较大提高，差异有统计学意义（P<0.05）;VEGF、IL-2和NF-κB表达水平显著降低，差异均有统计学意义（P<0.05）。结论　小剂量糖皮质激素可显著改善毛细血管渗漏综合征患者临床效果。

Abstract:

Objective　To investigate the therapeutic effect of small dose of glucocorticoid on patients with capillary leak syndrome.Methods　The research included 31 patients with capillary leak syndrome during May 2013 to July 2015.The patients were divided into control group and observation group. Control group were given conventional treatment, such as liquid recovery. On this basis, observation group was treated with small dose of glucocorticoid. To determine the recovery of patients in each group, all the patients were monitored for systemic edema and daily urine output. Central venous pressure, mean arterial pressure and serum albumin levels were also recorded. Peripheral venous blood was collected to measure the concentration of related cytokines in serum by enzyme-linked immunosorbent assay. Results 7 days after treatment, the mortality rate of observation group was significantly lower than control group. The average daily urine output increased obviously and edema turned out better. In the meantime, the central venous pressure and serum albumin in observation group recovered faster than control group, and cytokines VEGF, IL-2 and NF-κB had a certain degree of decline compared to control group.Conclusion　Small dose of glucocorticoid has a definite therapeutic effect on patients with capillary leak syndrome, reducing the mortality rate.