| Objective: To investigate the role of endothelial microparticles(EMPs)in the prognosis of sepsis and the effect of CVVH treatment on the level of EMPs in septic patients,so as to provide new reference for the diagnosis and treatment of septic patients.Methods: 45 septic patients who met the inclusion criteria from May 2018 to December 2019 in the ICU of The second hospital of Dalian Medical University were selected.According to different treatment methods,they were divided into two groups randomly: routine treatment group(n=22 cases),patients were treated with routine treatment according to the 2016 Surviving Sepsis Campaign(SSC)guidelines,and CVVH treatment group(n=23 cases),patients were treated with Continuous veno-venous Hemofiltration(CVVH)on the basis of 2016 SSC guidelines.In CVVH group,hemofiltration therapy was started within 6 hrs after sepsis was diagnosed.According to the patient's vascular conditions,convenient body position,etc.,select the appropriate position for central venous catheterization.CVVH treatment machine is a multi Filtrate machine manufactured by Germany's Fisenius Company.It uses blood filtration matching pipes and is treated continuously 16 hrs for 3 days.Blood was drawn intravenously before treatment and on the 3rd day of treatment respectively,and plasma EMPs were detected by flow cytometry to compare the changes of plasma EMPs levels between the two groups.The levels of tumor necrosis factor(TNF)and interleukin-6(IL-6)were determined by ELISA,and the changes of serum TNF-? and IL-6 levels were compared between the two groups;To analyze the correlation between plasmaEMPs,TNF and IL-6.To explore the role of plasma EMPs in judging the prognosis of sepsis.Results: 1.Changes of EMPs level in the two groups after treatment: The average plasma EMPs level was 1300.36±17.72(count/ul)in conventional treatment group,and1312.75±23.3(count/ ul)in CVVH group,P=0.057,which has no statistical significance.The average plasma EMPs level was 780.45±16.82(count/ul)in conventional treatment group and 550.00 ±16.91(count/ ul)in CVVH group,both were decreased on the 3rd day after treatment,P<0.001,which has statistical significance,and the CVVH group was significantly lower than the conventional treatment group,P<0.001,which has statistical significance(P < 0.05).2.Changes of inflammatory factors in peripheral blood of the two groups after treatment: The average concentrations of serum TNF-? was 60.36±5.67(pg/ml)in conventional treatment group and 59.40±6.35(pg/ml)in CVVH group,which has no statistical significance in these two groups.On the 3rd day of therapy,TNF-? decreased in both groups with conventional treatment group in 51.24±4.82(pg/ml),CVVH group in 38.41±5.36(pg/ml),P<0.001,which has statistical difference,and CVVH group was lower than conventional group,P<0.001,which has statistical difference;The average concentrations of serum IL-6 was 188.23±15.24(pg/ml)in conventional treatment group and 190.13±14.96(pg/ml)in CVVH group,which has no statistical significance in these two groups.On the 3rd day of therapy,IL-6 decreased in both groups with conventional treatment group in 102.57±17.97(pg/ml)and CVVH group in 47.42±18.34(pg/ml),P< 0.001,which has statistical difference,the concentrations of CVVH group were significantly lower than those of conventional treatment group,P<0.001,which has statistical difference;3.The average scores of APACHEII was 19.25±1.28 scores in conventional treatment group and 20.59±1.30 scores in CVVH group,P=0.080,which has no statistical significance in these two groups.On the 3rd day of therapy,APACHEII scores decreased in both groups with conventional treatment group in 16.25±1.82 scores and CVVH group in 13.02±2.11 scores,P < 0.001,which has statistical difference,andCVVH group was lower than conventional group,P < 0.001,which has statistical difference;The average score of SOFA was 7.56±1.63 scores in conventional treatment group and 7.34±1.75 scores in CVVH group,P=0.672,which has no statistical significance in these two groups.On the 3rd day of therapy,SOFA scores decreased in both groups with conventional treatment group in 4.26±0.23 scores,CVVH group in2.43±0.35 scores,P < 0.001,which has statistical difference,and CVVH group was lower than conventional group,P<0.001,which has statistical difference;4.Comparison of ICU hospitalization time and 28-day survival rate between the two groups: Comparing the hospitalization time of the two groups,the average hospitalization time of the conventional treatment group was 12.23 ± 1.39 days,while that of the CVVH group was 10.02±3.12 days,which has statistical significance(P=0.005 < 0.05);The 28-day survival rate was observed: 15 people survived and 7 people died in the conventional treatment group,20 people survived and 3 people died in the CVVH group,with no statistical significance(P=0.165 > 0.05).5.There was a moderate positive correlation between EMPs level and TNF-?level before treatment in the two groups(r=0.570,P < 0.05);There was a weak positive correlation between EMPs level and IL-6 level,but had no statistical difference(r=0.221,P=0.145).After treatment,EMPs expression level and TNF-? level in the two groups were significantly positively correlated(r=0.779,P < 0.05).There was a weak positive correlation between EMPs expression level and IL-6 level(r=0.304,P <0.05).There was a significant positive correlation between EMPs level and APACHEII scores before treatment in the two groups(r=0.740,P < 0.05);There was a weak positive correlation between EMPs level and SOFA scores,but without statistical difference(r=0.375,P=0.065).After treatment,EMPs expression level and APACHEII scores in the two groups were significantly positively correlated(r=0.624,P < 0.05).There was a weak correlation between EMPs expression level and SOFA scores,with no statistical significance(r=0.285,P = 0.167)Conclusion: 1.The increase of EMPs in peripheral blood of septic patients is related to the increase of TNF-? ?APACHEII and SOFA scores,which suggesting poorprognosis;2.CVVH has a significant clinical effect in the treatment of sepsis,reducing the level of peripheral blood EMPs,effectively reducing the release of inflammatory factors,reducing the damage of endothelial cells,and reducing the length of ICU hospitalization. |
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