| ObjectiveHemophagocytic syndrome (HPS) is one of the common and critical diseases in pediatrics with acute onset, rapid progress, complex etiology and high mortality. Until now; it’s still very difficult in clinical treatment, Hypercytokinemia and high inflammatory response are all important in pathogenesis of HPS.Hemoperfusion is one of the methods of blood purification which can effectively to eliminating the cytokines, toxins and poisons. To evaluate the efficacy of hemoperfusion in adjunctive treatment of children with HPS comparing with conventional treatment, we conducted a study in the children’s hospital affiliated to the Zhejiang University School of Medicine.Methods38 cases of children with HPS were collected from PICU of the children’s hospital affiliated to the Zhejiang University School of Medicine between August 2011 to August 2015, and were randomly divided into group undergoing conventional treatment and group undergoing conventional treatment+Hemoperfusion(HP) treatment. The latter was given HP treatment 2 to 3 hours each day for 3 days within 24 hours when diagnosis of HPS was confirmed. Maximum body temperature(T), total bilirubin (TBi1), Alanine transaminase (ALT), white blood cell count (WBC), hemoglobin (HGB) concentration, platelet (PLT) concentration, C reactive protein (CRP), cytokine(IL-10、 IFN-y) concentration of the two groups were observed and statistics analyzed before and after24,48,72 hours treatment. Clinical remission rate after 72 hours treatment is also observed and statistics analyzed.Results1. The maximum body temperature (T) decreased at 24 hours and 48hours of treatment comparing the beginning of treatment in HP group, the difference was no significant (p>0.05), at 72 hours of treatment comparing the beginning of treatment in HP group, the difference was significant (p<0.05);while in conventional treatment group maximum body temperature decreased at 24 hours,48 hours and 72 hours of treatment comparing the beginning of treatment with no significant difference (p>0.05), At 72 hours of treatment, the maximum body temperature in HP group was lower than in conventional treatment group, the difference was very significant (P<0.01).2. The total bilirubin decreased at 48 hours,72 hours of treatment comparing the beginning of treatment in HP group, the difference were significant(P<0.05); while in conventional treatment group, the total bilirubin decreased at 72 hours of treatment comparing the beginning of treatment was significant difference(P<0.05); At 72 hours of treatment, the total bilirubin in HP group comparing in conventional treatment group was no statistical significant difference (P>0.05).3. The alanine transaminase decreased at 48 hours of treatment comparing the beginning of treatment in HP group, the difference was significant (p<0.05), at 72 hours of treatment comparing the beginning of treatment in HP group, the difference was very significant (p<0.01); while in conventional treatment group, the alanine transaminase decreased at 24 hours and 48 hours of treatment comparing the beginning of treatment was no statistical significant difference(P>0.05),at 72 hours of treatment, the difference was very significant(P<0.01); At 72 hours of treatment, the alanine transaminase in HP group was lower than in conventional treatment group, the difference was very significant (P<0.01).4. The white blood cell count (WBC) increased at 48 hours of treatment comparing the beginning of treatment in HP group, the difference was significant (p<0.05), at 72 hours of treatment comparing the beginning of treatment in HP group, the difference was very significant (p<0.01); while in conventional treatment group, the WBC increased at 24 hours and 48 hours of treatment comparing the beginning of treatment was no statistical significant difference(P>0.05),at 72 hours of treatment, the difference was very significant(P<0.01); At 72 hours of treatment, the WBC in HP group was higher than in conventional treatment group, the difference was very significant (P<0.01).5. In two groups, the hemoglobin(HGB) concentration after treatment comparing the beginning of treatment was no statistical significant difference(P>0.05); At 72 hours of treatment, the HGB concentration between the two groups also had no statistically significant differences(P>0.05).6. The PLT count increased at 24 hours of treatment comparing the beginning of treatment in HP group, the difference was significant (p<0.05), at 48 hours and 72 hours of treatment comparing the beginning of treatment in HP group, the difference was very significant (p<0.01); while in conventional treatment group, the PLT count increased at 24 hours and 48 hours of treatment comparing the beginning of treatment was no statistical significant difference(P>0.05),at 72 hours of treatment, the difference was very significant(P<0.01); At 72 hours of treatment, the PLT count between the two groups had no statistically significant differences(P>0.05).7. The CRP concentration decreased at 24 hours of treatment comparing the beginning of treatment in HP group was no statistical significant difference(P>0.05),at 48 hours and 72 hours of treatment, the difference was very significant(P<0.01); while in conventional treatment group, the CRP concentration decreased at 24 hours and 48 hours of treatment comparing the beginning of treatment was no statistical significant difference(P>0.05),at 72 hours of treatment, the difference was very significant(P<0.01); At 72 hours of treatment, the CRP concentration between the two groups had no statistically significant differences(P>0.05).8. The IL-10 and IFN-γ concentration in serum decreased at 24 hours of treatment comparing the beginning of treatment in HP group were no statistical significant difference(P>0.05),at 48 hours and 72 hours of treatment, the difference were very significant(P<0.01); while in conventional treatment group, the IL-10 and IFN-y concentration in serum decreased at 24 hours and 48 hours of treatment comparing the beginning of treatment were no statistical significant difference(P>0.05), at 72 hours of treatment, the difference were very significant(P<0.01); At 72 hours of treatment, the serum concentration of IL-10 and IFN-y in HP group were lower compared with in conventional treatment group, the differences was very significant (P<0.01).9. At 72 hours of treatment, there were 17 cases in clinical remission in HP group, the clinical remission rate was 77.27%;while 7 cases in clinical remission in conventional treatment group, the clinical remission rate was 43.75%;Clinical remission in HP group was higher which was significant compared with in conventional treatment group (p<0.05).10. No HP related complications occurred in the HP group.ConclusionCompared with in conventional treatment group, HP group was more helpful to eliminate the cytokines and inflammation response. HP treatment can reduce severity and improve the prognosis of HPS. HP treatment is an effective and safe therapeutic method for HPS in child. |
PDF Full Text Request