| IntroductionMODS is one of the major reason for the death of critical patients. In current, we have no effective therapy for MODS patients yet. The mechanism of MODS is keeping unclear, although the hypothesis of " overwhelming inflammation " has become the most popular one by now. When the body suffered from trauma or infection, a lot of pro-inflammatory and anti-inflammatory mediators would be produced, which often followed with overwhelming inflammation response and the disturbance of homeostasis. That would result in SIRS, MODS and finally death. Continuous renal replacement treatment (CRRT) is not only conceived as a replacement of the lost renal function, but also plays an important role in the therapy of serious inflammation asimmuno-modulator, by removing many soluble pro-inflammatory and anti-inflammatory mediators. By this reason, CRRT become a novel important treatment in SIRS/MODS. It has been accepted widely that continuous high volume hemofiltration (CHVHF) can remove these mediators more effectively than other hemofiltration . methods. However, the detail mechanism of CRRT in treatment of MODS and its influence on immune systems are still unclear. The purpose of this study was to investigate the influence of immune system of HVHF on MODS.Materials and methods1. Clinical data collectionA prospective study of 21 patients with MODS who underwent continuous high-volume hemofiltration between Nov.2004 and Apr.2005 was studied. The outcomes of the patients were recorded. 13healthy people served as control.2. Method of HVHFAll of the 21 patients underwent high volume veno-venous hemofiltration with a polysulfone filter (F60, 1.3 m2 ).The ultrafiltrate rate was 5000 ml/h and blood flow was 200~300 ml/min. The substitute fluid was infused with pumps pre and post filter.3. Detection of cytokines in serum and immune cell functionsPlasma levels of IL-1 ,IL-6,IL-10 and TNF-α were detected by ELISA assay. The antigen presenting function of whiteblood cells represented by HLA-DR expression was detected by flow cytometry analysis. T lymphocytes subsets (CD4, CD8 and CD4/CD8) were detected by immunofluorescence. Data from 13healthy people served as control.7.Statistical analysisFor statistical analysis, SPSS for windows vision 10.0 was used. A P value <0.05 was considered statistically significant.Results1. CHVHF was well tolerated in all the patients expect one gave up after 35 hours of CHVHF for other reasons. In these 21 patients, 12 patients survived through the 28 days' observation period after CHVHF treatment (survive rate 57.1%), and finally 8 patients survived until now (survive rate 38.1%), in which 2 patients receiving hemodialysis therapy regularly.2.Compared with pre-treatment, serum levels of creatinine and urea were significantly decreased at the 24 hour of CHVHF (P<0.01).3.The serum levels of IL-1 and IL-6 were not significantly changed during CHVHF treatment in MODS patients4. A significant decrease of serum IL-10 was observed at the 12 hour of CHVHF treatment (P<0.05).5. Compared with pre-treatment, serum TNF-α levels weresignificantly decreased at the 6 hour of CHVHF (P<0.05), and very significantly decreased at the 12 hour (P<0.01).6.The expression of HLA-DR on white blood cells in MODS patients were significantly lower than that in healthy controls(P < 0.001).Compared with pre-CHVHF, HLA-DR levels were significantly improved at the 6 hour of CHVHF (P<0.05), and very significantly improved at the 12 hour (P<0.01).7.MODS patients had a significant lower CD4 level before HVHF than adult healthy controls (p < 0.001).There were no statistical difference of CD8 and CD4/CD8 ratio between MODS patients before HVHF and the controls (P=0.833 and 0.09 respectively). Compared with pre-HVHF, CD4 and CD4/CD8 levels were significantly increased at the 12 hour of HVHF (P=0.006 and 0.046 respectively).8. Serum levels of cytokine, CD4, CD8 and HLA-DR were not significantly changed during between death and survival in MODS patientsConclusions1.Compared with that before HVH... |
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