Effect of pulsehigh-volume hemofiltration on cellular immunity in patients with sepsis

Abstract

：Objective To study theeffects of pulse high volume hemofiltration (PHVHF) on the changes of Th17 cells (T helper17 cells) and CD4 + CD25 + reguratory T cells (Treg cells) in peripheral blood of patientswith sepsis and to evaluate the clinical value of this intervention. Methods The patientswere included in this prospective study as per the criteria of sepsis set by America ChestPhysicians College/America Society for Critic Care Medicine in 1992. The patients wereexcluded: ① immune system disorder,② acute stroke, ③ myocardial infarction, ④ virus hepatitis,⑤ human immunodeficiency virus infection, ⑥ under immunosuppressive therapy. Forty patients (24 males, 16females, aged from 25 to 75years) with sepsis in ICU were enrolled from January. 2008 toNovember. 2010. According to the severity of disease, the patients were divided into threegroups; moderate sepsis group (n = 14, 8 males, 6 females) , severe sepsis group (n = 15,9 males, 6 females) , and septic shock group (n = 11, 7 males, 4 females). The initiallyclinical data of three groups were comparable. Twenty healthy individuals served ascontrols. According to the mode of treatment, forty patients were also divided into twogroups: conventional treatment group (group A, n= 15) in which patients were treatedwithout PHVHF within 5 days after admission and trial group (group B, n=25) in whichpatients were treated with pulsed high volume hemofiltration (PHVHF) within 5 days afteradmission. In group B, high volume hemofiltration (70 mL · kg-1 · h-1) wasgiven to patients for 6 ～ 8 hours, and then conventional continuous vein - veinhemofiltration (35 mL · kg-1 · h-1) for 16 ~ 18 hours. The total length ofperiod for continuum blood scavenging was 24 hours as one cycle. The interval between twocycles of blood scavenging was 24 hours. The changes of Th17 cells and CD4+ CD25 + Tregcells of 40 patients were detected with flow cytometry on the 1st day and the 5th dayafter admission. The data were analyzed by using SPSS version 13. 0 software. Measurementdata were analyzed with Paired-samples t-test, independent-samples t-test or one way ANOVA. Ratio of small samples was compared with fisher's exact test, and the correlation wasanalyzed by using Pearson correlation analysis. Results The rates of Th17 cells were( 0.91±0.38)%, (2.09 ±0. 53)% , (3.90 ±0. 80)% , and ( 1. 85 ±0.35)% in control, moderatesepsis, severe sepsis, and septic shock groups, respectively, while the rates of CD4+CD25+ Treg cells were (0.39 ±0.23)%, (1. 72 ±0. 59)% , (2.72 ±0. 22)% , and (3. 55 ±0.51)% , respectively. The rate of Thl7 cells on the 1st day was higher in severe sepsisgroup than that in other two groups ( P 0. 05). Moreover , the rate ofCD4+ CD25 + Treg cells was up - regulated on the 1st day in the following order from highto low: septic shock group > severe sepsis group > sepsis group (P < 0.05). Therates of Th17 cells and CD4 + CD25 + Treg cells in patients of group B decreased ingreater degree than that did in patients of group A (P < 0.05 ). Conclusions Thechanges of Th17 cells and CD4 + CD25 + Treg cells may play an important role inpathogenesis of sepsis, and the pulsed high volume hemofiltration may be one of theeffective treatments for the patients with sepsis by regulating the rates of Thl7 cellsand CD4 + CD25 + Treg cells. Key words: Sepsis; Severe sepsis; Septic shock; Cellular immunity; Thelper 17 Cells; CD4+ CD25 + T regulatory cells; Pulse high volume hemofiltration; Immunoregulation CD25'T regulatory cells; Pulse higll volumehemofiltration; Immunoregulation