Effcts Of Aminoacid Level During Contious High Volume Hemofiltration On Immune Function Of Critical ILL Patients With Acute Kidney Injury

Objective to observe the effects of aminoacid level during contious high volume hemofiltration (CHVHF)on immune function of critical ill patients with acute kidney injury(AKI).Method A total of20patients diagnosed with MODS company with AKI and would be recept CBP for24hours were selected in this study, who stayed in our intensive care unit in the period of September2011to February2011. They were randomly divided into two groups on condition whether they received aminoacid or not during CBP. The2groups were received total parenteral nutrition (TPN) of146kJ/(kg. d) through jugular vein or femoral vein.The first group without aminoacid supplement was considered as HVHF group, the other group given aminoacid of2.5g/(kg. d) including0.3g/(kg. d) Gln, was considered as HVHF+AA group. Serum prealbumin (PA), albumin (ALB), creatinine (SCr), blood urea nitrogen (BUN), Serum free amino acid spectrum, immuneglobulin, lymphocyte CD4+/CD8+, the phagocytosis rates and phagocytosis indexes of polymorphonuclear neutrophil (PMN), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) were monitored before and after CBP. Results Compared with pre-treatment,the level of PA, ALB in the HVHF group reduced significantly,while improved in HVHF+AA group, the difference of the level between2groups was statistically significant(P<0.05). SCr, BUN (P <0.05) were decreased after the treatment,but the difference between2groups was not statistically significant(P>0.05). After treatment, the concentration of all amino acids was lower in HVHF group, the difference of that in all the essential amino acids except leucine, glutamine, arginine was statistically significant (P<0.05). The concentration of all amino acids in the HVHF+AA group was increased after treatment, most of which was different statistically (P <0.05). After treatment, the concentration of all the essential amino acids, glutamine, arginine in HVHF group was lower than that of HVHF+AA group, the difference was statistically significant (P<0.05).The phagocytosis rates(P<0.05), phagocytosis indexes (P<0.05) of PMN and lymphocyte CD4+/CD8+(P <0.05) were increased after the treatment, the HVHF+AA group was superior to the HVHF group,the difference between2groups was statistically significant (P<0.05). the level of immune globulin(P<0.05) was increased in2groups, but the difference was not statistically significant (P>0.05). Scores of APACHE Ⅱ (P<0.05) were decreased after the treatment, and difference between2groups was not statistically significant (P>0.05).Conclusion HVHF is an effective selection to improve the immune function of MODS with AKI, but the aminoacid losses during CBP might affect the Serum free aminoacid concentration, which might affect the patients immune function.The supplement of aminoacid during CBP might increase the Serum free aminoacid concentration, and so improve the immune function of the critical ill patients, especially the cellular immune function.The supplement also made the state of nutrition of the patients better,but had less effect on the clearance of SCr and BUN.