Clinical study on blood hemoperfusion resin adsorption series connected continuous venous-venous hemofiltration treating the patients with multiple organ dysfunction syndromes

Abstract

Objective To investigate the effect of blood hemoperfusion with resin adsorption connected in series to continuous veno-venous hemofiltration （ HP ＋ CVVH ） on plasma cytokines such as TNF-a, IL-1 B, IL-6 as well as cellular immunity and prognosis of patients with multiple organ dysfunction syndromes （MODS） . Methods It was a prospective, randomized clinical trial. A total of 30 patients diagnosed as MODS were randomly （random number） divided into routine treatment ＋ HP ＋ CVVH group （treatment group） and routine treatment ＋ CVVH group （control group）. In treatment group, patients received blood hemoperfusion with resin adsorption for 2 hours, and then CVVH for 10 hours every day for 3 days. In control group, patients received CVVH for 12 hours every day for 3 days. The plasma samples of patients in treatment group were obtained0 h, 2 h, 12 h, 24 h, 26 h, 36 h, 48 h, 50 h, 60h, 5 days , 7 days and 10 days after renal replacement therapy. The plasma samples of patients in control group wereobtained 0 h, 12 h, 24 h, 36 h, 48 h, 60 h, 5 days, 7 days and 10 days after renal replacement therapy. All of these patients were monitored with APACHE II score, T-lymphocytes subpopulations, blood lactate acid concentration, heart rate, respiration rate and oxygenation index. Results Plasma levels of TNF-ct, IL-113 and IL-6 decreased dramatically after HP （ P 〈 0. 01 ） and T-lymphocytes subpopulations CD3 ＋ , CIM ＋ , CD8 ＋ and CD4 ＋/CD8 increased after both HP ＋ CVVH and CVVH. The differences in plasma levels of TNF-a, IL-1Band IL-6 of patients between two groups were not noticeably obvious at the intervals of 12 h, 36 h, and 50 h after renal replacement therapy. But on the 5 th day after renal replacement therapy, plasma levels of TNF-a, IL-1Band IL-6 of patients in HP ＋ CVVH group were lower than those in control group （ P 〈 0. 05 ）. There were 5 fatal patients in HP ＋ CVVH group and 6 patients died off in CVVH group during 28 days after treatment. Conclusions Both HP ＋ CVVH and CVVH could lower the levels of plasma TNF-a, IL-1B and IL-6, and improve cellular immunity and clinical symptoms as well as signs. Compared with CVVH, plasma levels of TNF-ct, IL- 1B and IL-6 were lower on the 5th day and increase rate of 28-day survival in HP ＋ CVVH group. Key words: Hemoperfusion with resin adsorption; Continuous venous-venous hemofiltration; Multiple organ dysfunction syndromes; Cytokines