Hemoperfusion Removal Effect In Inflammatory Cytokines And C-reactive Protein Hemoperfusionin Patients In Acute Severe Organic Phosphorus Poisoning

Purpose: Acute organic phosphorus poisoning(AOPP) is a common clinical emergency, though with the early application of atropine and enough cholinesterase reactivator, the success rate of rescuing severe AOPP has dramatically increased, but the fatality rate is as high as 26.2%, especially in severe cases. Recent years, researchers begin to pay attention to AOPP with systemic inflammatory response syndrome(SIRS) and multiple organ failure syndrome(MODS). After enter the body, organophosphorus pesticides can activate the immune active cells, such as neutrophils and macrophages and induce inflammation, secrete a large number of inflammatory factors such as TNF-α and IL-1.TNF–α and IL-1 are the important proinflammatory cytokines. The increase of TNF–α and IL-1will induce hepatic synthesis of a large number of C-reactive protein(CRP). CRP in healthy human serum is low. After inflammation and tissue injury, CRP concentration increased rapidly. After entering the body, organophosphorus can cause SIRS, induce the significantly increase of CRP. The CRP is a extremely sensitive indicator of tissue injury and infection.Research shows that the SIRS is the basis of MODS, runaway release of inflammatory factors is the key of MODS. So early removal of excessive release of inflammatory factor is the key to blocking AOPP into MODS early. As a kind of macromolecular fat-soluble toxin, after into the blood, most of organic phosphorus pesticide can inhibit the activity of acetylcholinesterase and make it losing the ability of the hydrolysis of acetylcholine. The accumulation of acetylcholine alkali in the synaptic cleft cholinergic nerve can induce a series of nervous system symptoms. The early clear organic phosphorus and inflammation caused by it become the key subject of clinical therapy to treating AOPP,except for the early application of atropine and cholinesterase. Hemoperfusion(HP) is a way to remove toxins, which from the blood of exogenous or endogenous relative molecular weight, fat soluble, high protein binding rate of poison,by extracorporeal circulation through the blood of adsorption device(adsorption tank). The hemoperfusion of acute poisoning have good curative effect. This research through the observation of the change of TNF–α,IL-1and CRP after HP, to further confirm the removal effect of inflammatory cytokine sand CRP hemoperfusion in acute severe organic phosphorus poisoning patients:Methods : 94 patients of AOPP(included 28 male and 66female) hospitalized,in the emergency department of the First Hospital of Handan from 2010 12 th to 2014 4th were involved in this study.According to whether using hemoperfusion、voluntary、economic conditions、sign the informed consent, the patients divided into hemoperfusion group(research group,46cases) and the no hemoperfusion group(control group,48cases). All patients were confirmed OPP by identification of poison diagnosed with severe AOPP standards. Some patients have different degree of multiple organ damage and be diagnosed with MODS. There was no significant difference on comparable in gender, age, degree of disease, in a critical condition and the experimental results of Patients in the two groups. All patients were given conventional treatment: gastric lavage, catharsis, adequate cholinesterase complex agent,a moderate amount of atropine and support treatment after admission. The control group have conventional treatment only;the research group have conventional treatment and 1 hemoperfusion,and may have repeated hemoperfusion according to the condition. IL-1,TNF-α and CRP were tested for instantly, 12 h, 24 h after admission(some patients were tested again after 48 h). SPSS 13.0 statistical software is applied for analysis and the measurement data is described in X 土 S. The comparison between the two groups adopt t-test, the comparison of the two groups of repeated measurement data adopt analysis of variance,comparing two use Dunnett method or SNK method;Classfication of variables in the two groups by X2 test.P<0.05 was statistically significant.Results:1 The research group and control group were compared that expressed the two groups have no difference in gender, age, type, cholinesterase and they are comparable.2 HP’s influence on TNF–α, IL-1and CRP:Hospitalized instantly,there were no significant differences in TNF–α, IL-1and CRP between two groups(P>0.01)。Levels of TNF–α, IL-1 and CRP were down-regulated at 12 hours and 24 hours after be hospitalized HP treatment in research group(P<0.01). An internal comparison revealed that the levels of TNF–α, IL-1and CRP were lower in the research group than the control group(P<0.01). In control group, the levels of TNF–α, IL-1 and CRP had no obvious change compared with at 12 hours(P>0.05). However, the levels of TNF–α, IL-1 and CRP were obviously up-regulated at 24 hours after treatment compared with hospitalized instantly(P<0.05).3 the changes of TNF–α, IL-1and CRP after two times hemoperfusion after one time hemoperfusion, there are 9 cases(20%) in the levels TNF–α, IL-1 and CRP which had no significant differences after HP treatment in research group(P>0.05). After two times HP, the levels in research group had down-regulated at 48 hours(P<0.05).4 the changes of serum TNF–α, IL-1and CRP after three times hemoperfusion there were still 5cases(10%), coming from 9cases(20%) having two times hemoperfusion, which were no significant differences in the levels of TNF–α, IL-1and CRP after HP treatment. Then after three times HP for 5 cases, the levels of TNF–α, IL-1and CRP had down-regulated at 72 hours(P<0.05).5 Clinical curative effect comparison of two groups: after treatment, in the research group,43 cases were cured, 3 cases died. in the control group, 38 cases were cured, 10 cases died;Cure rate of research group was obviously higher than the control group(P = 0.042, P < 0.05).Conclusions:1 Inflammatory factor(TNF–α, IL-1) and CRP levels after 12 h compared with control group decreased significantly. It indicates that early hemoperfusion can remove inflammatory factor effectively, intervene in the inflammatory reaction, protect viscera function, help to improve the prognosis of patients with severe AOPP.2 In patients with severe AOPP, basic treatment has certain scavenging effect on TNF-α、IL-1 and CRP, and the basic treatment combined with hemoperfusion can remove them more effectively and have a more apparent effect,effectively improve the case cure rate.3 TNF-α, IL-1 and CRP in some severe AOPP patients still continue on a higher level after active treatment. It may be associated with sustained release of inflammatory factors, it is necessary to repeat the hemoperfusion treatment.