| Objective:To study the concentration levels of sepsis plasma platelet-activating factor(PAF), thromboxane B2(TXB2) and6keto prostaglandin F1α (6-keto-PGF1α) and to explore the role of the above-mentioned factor in the development of the disease pathophysiological process of sepsis,we observed PAF,TXB2and6-keto-PGF1α changes in the concentration level of the sepsis plasma and the general condition of patients changes before and after continuous blood purification (CBP) treatment, in order to observe the influence of CBP treatment on the vasoactive substances,then we explore the function of CBP treatment to the vascular endothelial cell and the impact of CBP treatment on the patients’ clinical efficacy.Methods:To selected16patients from January2012to December2012, who were accepted treatment in the second hospital of Hebei medical university complied with sepsis diagnostic criteria (according to the diagnostic criteria for sepsis which1991meeting of the American College of Chest Physicians Society established).16patients received the CBP treatment and we define the group as treatment group.There were male9and female7with a mean age48.31±21.62years old. We selected16cases accepted normal healthy subjects in our hospital in the same period as a normal control group,there were male8and female8with a mean age50.03±17.28years old. The two groups is not statistically significant in gender, age difference. The patients of CBP treatment group were indwelled with double lumen catheter in the femoral vein (most on the right)using the Sledinger technology and accepted12hours CBP treatment.We respectively collected blood3ml before treatment (T0),2h after treatment (T1),6h after treatment (T2), after treatment12h that was the end of the treatment time (T3),24h after treatment,that is12h after the end of treatment12h (T4) in the cubital vein. Then we centrifuged supernatant and stored at-20℃low temperature refrigerator. We recorded patient vital signs (T, HR, BP,) and we scored the patients with APACHE score dynamically. We collected cubital venous blood samples3ml of healthy control group in the early morning and we centrifuged and cryopreserved supernatant in the same way. We measured concentration levels of PAF, TXB2and6-keto-PGF1α by ELISA. We compared PAF, TXB2and6-keto-PGF1α plasma concentration levels in different time of the treatment group and compared the levels of the above factors the CBP treatment group with the healthy control group,. All data are expressed as mean±standard deviation (x±s),We compare the different between the two groups using independent sample t-test and we compare the different of various parameters in different treatment time of the the sepsis treatment group using paired t-test.P<0.05was significantly different, analysed with SPSS statistical software ver.13.Results:1. The plasma concentration levels of PAF, TXB2(T0) in sepsis patients are higher than the levels in healthy control group(N) significantly. The plasma concentration level of6-keto-PGF1α(T0) was less than healthy controls group (N).To compare the three sets of data in statistical methods we calculate P values,P<0.05, all were significant.TXB2/6-keto-PGF1α ratio of sepsis treatment group (T0) was higher than the ratio of normal level of the control group, P<0.05It was considered statistically significant.2. Changes of PAF, TXB2,6-keto-PGFIa, and TXB2/6-keto-PGF1α in CBP treatment2.1The plasma concentration levels of PAF decreased after CBP treatment, and were statistically significant, P<0.05. The concentration level of PAF in different treatment timeT1, T2, T3, T4is not statistically significant (P>0.05).2.2After CBP treatment, TXB2levels (T1, T2, T3, T4)averaged less than treatment before (TO), but the P values were greater than0.05, not statistically significant;Plasma concentration levels of TXB2inT3, T4were no significant change.2.3The plasma concentration levels of6-keto-PGF1α had a upward trend compared With the CBP before treatment (T0). compared TO With Tl,there was no statistically significant (P>0.05), T2and T3were statistically significant compared with T0,plasma concentration of6-keto-PGF1α inT1, T2, T3and T4was not statistically significant.2.4TXB2/6-keto-PGF1αratio lower than before after CBP treatment, they were statistically significant, change of ratio inT2, T3, T4were not statistically significant.3. Patients generally change after CBPThe body temperature, heart rate in patients were decreased after CBP treatment than before, P values were less than0.05considered statistically significant. After CBP The MAP of patients was higher than before, but not statistically significant (P>0.05). APACHE Ⅱ score (T3, T4) of CBP treatment patients were decreased than before, compared T0with T3, T4,there were statistically significant but compared T4withT3, there was not statistically significant.Conclusions:1. Sepsis patients exist with impaired endothelial function and vasomotor dysfunction.2.The dysfunction of vascular endothelial secretion causes the vasomotor dysfunction in sepsis patients is one of the mechanisms in the development of sepsis pathophysiology.3.CBP treatment can clear vasoactive substances, improve endothelial cell function, improve vasomotor function in patients with sepsis continuously, thereby improve the general situation of sepsis patients. |
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