Effect Of Continuous Veno-venous Hemofiltration On The Peripheral Blood Levels Of Mediators Of Inflammation In Patientes With Systemic Infla-mmatory Response Syndrome Or Sepsis

Objective To investigate the effect of mediators of inflammation on the peripheral blood levels of HMGB-1,TNF-α,IL-6 and the mechanism of action of HMGB-1 in patients with systemic inflammatory response syndrome or sepsis;meanwhile to observe the benefit of clinical symptom and prognosis of petients with systemic inflammatory response syndrome or sepsis.Methods Thirty patients with SIRS or sepsis in Intensive care unit of our hospital were scheduled for treatment of CVVH.Eighteen of these patients are male,twelve are female.Mean age was 40.17±10.1 years old.All patients met the diagnostic criteria of SIRS or sepsis.A double truck catheter was put into right internal jugular vein.CVVH was done with the Cambro Lundia AB and Prismaflex M100 AN69 HF and lasted eight hours.The replacement liquid was put in by the pattem of pre-dilution of 40% and post-dilution of 60%.The flow was 3 liter per hour.The blood flow was from 200 milliliters to 300 milliliters per minute.Treatments included the management of primary disease and maintenance of main organ and system function.5 milliliters blood from right radial artery was got at the time points of pre-CVVH,CVVH2h,6h,8h and post-CVVH 12h and the serum was stored at the temperature of -20℃after high speed centrifugation,and 2 milliliters filter liquor was reserved at the time point of CVVH6h.The concentration of serum and filter liquor HMGB-1 was measured by ELISA,but that of TNF-αand IL-6 were measured by radioimmunity.The HR,MAP,Rf,PaO₂/FiO₂,APACHEâ…¡score and the arterial blood gas were recorded and measured at the time points above.The blood concentration of lactic acid and C reactive protein were recorded pre-CVVH and 12h post-CVVH. Results The initial concentration of serum HMGB-1 was 13.87±4.68ng/ml,and decreased to the minimum(11.88±6.06ng/ml) at 2h following CVVH,then increased,but was lower than that pre-CVVH and there was no significant difference compared with that pre-CVVH.The concentration of filter liquor HMGB-1 was (12.14±2.22 ng/ml).The concentration of serum TNF-αbegan to decrease at 2h following CVVH,and got to the minimum at 2h,then increased,but was lower than that pre-CVVH,and there was significant difference compared with that pre-CVVH. The concentration of filter liquor TNF-αwas(0.23±0.28ng/ml).The concentration of serum IL-6 began to decrease at 2h following CVVH,and got to the minimum at 6h,and increased at 12h post-CVVH,but it was still lower than that pre-CVVH,and there was significant difference compared with that pre-CVVH.The concentration of filter liquor IL-6 was(198.37±91.17 pg/ml).The concentrations of serum LAC and CRP post-CVVH were lower those pre-CVVH,and there was significant difference compared with those pre-CVVH.The HR and Rf decreased following CVVH,and there was significant difference compared with that pre-CVVH.The MAP had no marked change during after and post-CVVH,and there was no significant difference compared with that pre-CVVH.The dose of NE and the APACHEâ…¡score decreased following CVVH,and there was significant difference compared with those pre-CVVH.Conclusions1 CVVH could remove TNF-α,IL-6,LAC,CRP in peripheral blood of patients with systemic inflammatory response syndrome or sepsis,and could decrease patients'APACHEâ…¡scores.2 CVVH could decrease the concentration of HMGB-1 in peripheral blood,which would be one of the mechanisms of action for CVVH on sepsis.3 CVVH could maintain patients' vital signs stable and could improve their clinical symptoms,CVVH had an invariable therapeutical effect on patients with systemic inflammatory response syndrome or sepsis.