| Objective: To certain the effect of serum inflammation media IL-10、TNF-α,arose by PQ poisoning,after different methods of blood purificationbased on the HP treatment, which is in order to explore the clinical therapeuticeffect and prognosis and to provide the reference of standard treatment for PQpoisoning.Methods: Thirty patients of PQ poisoning(inclued15male and15female)hospitalized,in the emergency department of the Second Hospital of HebeiMedical University from20126thto20136thwere involved in this study,thepatients with no previous history of lung、liver、kiddney and other organs ofunderlying disease.Patients were randomly divided into two groups:groupA(group of2HP+3HD):15;group B(group of2HP+2HD):15.Patients in thetwo group showed no statistical significant difference in age,the amount ofpoisoning,the time of the first blood purification and the concentration of PQat the patient arrived hospital.The patients in A、B group, based on physicaltreament,respectivly was treated with2hours HP+3hours HD and2hoursHP+2hours HD, the time from poisoning to the first blood purification waslimited in12hours, the interal of every blood purification was8-10hours.HPwas adopted HA330resin and HD was adopted polysulfone membrane.Thetwo groups,respectivly,were taken5ml venour sample before every bloodpurification and after,then given the high-speed centrifugation for10minutes,with4000r/min. After centrifugation, the upper serum in EP tube labeled, andput in-80℃refrigerator to save for the spare.All specimans werecollected,IL-10、TNF-α were detected unified by ELISA.SPSS19.0statisticalsoftware is applicatied for analysis.If the measurement data is distributed innormal or nearly normal, the measurement data is described in Χ±S, if not,inmedian/interquartile range.If the data of two groups with normal distribution and homogeneity of variance,the comparison is adopted by t-test, if not,bywilcoxon rank sum test.The mortality of two different blood purificationtreated with patients of PQ poisoning were compared in the chi-square test,P＜0.05was statistically significant.Results:115patients in group A with PQ poisoning based on physical treatmentwere given2HP+3HD,7patients died,the case fatality rate was46.67%.15Patients with PQ poisoning in group B based on physical treatment were given2HP+2HD,9patients died,the case fatalilty rate was60.00%.There was nosignificant difference between the two groups(P＞0.05).2In group A, compare the concentration of IL-10before the2HP+3HDwith the concentration of IL-10after the2HP+3HD(Median/InterquartileRange),there was significant difference between every treatment of2HP+3HD(HA1b28.20/285.11pg/ml VS HA1a26.48/46.32pg/ml，P=0.001；HA2b28.35/40.84pg/ml VS HA2a17.63/11.36pg/ml， P=0.001；HA3b21.97/103.42pg/ml VS HA3a16.93/18.48pg/m， P=0.001；HA4b19.6/1.61pg/ml VS HA4a16.98/1.87pg/ml， P=0.003);compare theconcentration of TNF-α before the2HP+3HD with after the2HP+3HD(Median/Interquartile Range),there was significant differencebetween every treatment of2HP+3HD(HA1b3.41/5.51pg/ml VSHA1a1.95/5.14pg/ml，P=0.023；HA2b5.25/5.21pg/ml VS HA2a3.41/4.40pg/ml，P=0.001； HA3b4.51/3.71pg/ml VS HA3a2.68/2.55pg/ml， P=0.001；HA4b1.95/2.19pg/ml VS HA4a0.86/1.45pg/ml，P=0.003).3In group B,compare the concentration of IL-10before the2HP+3HDwith the concentration of IL-10after the2HP+2HD(Median/InterquartileRange),there was siginificant difference between every treatment of2HP+2HD(HB1b23.89/324.28pg/ml VS HB1a18.56/199.74pg/ml，P=0.023；HB2b28.05/497.61pg/ml VS HB2a17.4/203.53pg/ml， P=0.001；HB3b27.61/241.38pg/ml VS HB3a16.93/18.48pg/ml，P=0.002；HB4b20.17/4.67pg/ml VS HB4a16.89/2.18pg/ml，P=0.018);compare the concentration ofTNF-α before the2HP+3HD with after the2HP+3HD(Median/Interquartile Range),there was significant difference between every treatment of2HP+2HD(HB1b4.14/4.03pg/ml VS HB1a2.31/2.55pg/ml， P=0.007；HB2b6.36/11.18pg/ml VS HB2a4.14/6.26pg/ml，P=0.001；HB3b4.51/7.43pg/mlVS HB3a2.31/4.02pg/ml， P=0.001； HB4b3.77/2.55pg/ml VSHB4a1.59/2.53pg/ml，P=0.043)4In group A,compare the concentration of IL-10after the everytreatment of2HP+3HD with the concentration of IL-10before the next2HP+3HD (Median/Interquartile Range),there was siginificant differencebetween every comparison(HA1a26.48/46.32pg/ml VS HA2b28.35/40.84pg/ml，P=0.041； HA2a17.63/11.36pg/ml VS HA3b21.97/103.42pg/ml， P=0.001；HA3a16.07/1.94pg/ml VS HA4b19.6/1.61pg/ml， P=0.041);compare theconcentration of TNF-α after the every treatment of2HP+3HD with theconcentration of TNF-α before the next2HP+3HD (Median/InterquartileRange),there was siginificant difference between everycomparison(HA1a1.95/5.14pg/ml VS HA2b5.25/5.21pg/ml， P=0.002；HA2a3.41/4.40pg/ml VS HA3b4.51/3.71pg/ml，P=0.007；HA3a2.31/1.82pg/mlVS HA4b1.95/2.19pg/ml，P=0.014).5In group B,compare the concentration of IL-10after the every treatmentof2HP+2HD with the concentration of IL-10before the next2HP+2HD(Median/Interquartile Range),there was siginificant difference between everycomparison(HB1a18.56/199.74pg/ml VS HB2b28.05/497.61pg/ml，P=0.012；HB2a17.4/203.53pg/ml VS HB3b27.61/241.38pg/ml， P=0.009；HB3a18.34/2.84pg/ml VS HB4b20.17/4.67pg/ml， P=0.018);compare theconcentration of TNF-α after the every treatment of2HP+2HD with theconcentration of TNF-α before the next2HP+2HD (Median/InterquartileRange),there was siginificant difference between everycomparison(HB1a2.31/2.55pg/ml VS HB2b6.36/11.18pg/ml， P=0.001；HB2a4.14/6.26pg/ml VS HB3b4.51/7.43pg/ml，P=0.016；HB3a1.59/2.91pg/mlVS HB4b3.77/2.55pg/ml，P=0.018).6Campare the difference of IL-10after every treatment of2HP+3HDwith2HP+2HD,there was no siginificant difference between2HP+3HD and 2HP+2HD group(HA1VS HB1，P=1.0； HA2VS HB2，P=0.72；HA3VS HB3，P=0.69；HA4VS HB4，P=0.39).7Campare the difference of TNF-α after every treatment of2HP+3HDwith2HP+2HD, there is no siginificant difference between2HP+3HD and2HP+2HD group (HA1VS HB1，P=0.55； HA2VS HB2，P=0.55；HA3VSHB3，P=0.77； HA4VS HB4，P=0.75).Conclusion:1Hemoperfusion(HP) and hemodialysis(HD) can effectively clean up theserum inflammation media related to MODS and arouse by PQ poisoning, soas to alleviate the systemic inflammatory response.2The inflammatory response in the patients of acute PQ poisoning wouldbe persistent, and the interval blood purification can temporarily clean up thepoison and the serum inflammation media, the interval would be made furtherexploration.3When hemoperfusion combined hemodialysis was carried out to savethe patients of acute PQ poisoning, the reinforcing hemodialysis treatment cannot clean up the inflammation media effectively, the way of specific bloodpurification would be improved. |
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