Effect Of Continuous Veno-Venous Hemofiltration On Serum TNF-α, IL-10 And No In Mods Patients

Multiple organ dysfunction syndrome (MODS) is the end stag e of many lethal infectious and non-infectious diseases.Now,the dissonance between pre-inflammatory and anti-inflammatory mediators is considerd to be one of the main mechanisms of MODS.Therefore,the key of treating MODS is to remove inflammatory mediators with middle and large molecular weight. That continuous renal replacement treatment (CRRT) could remove these inflammatory mediators has been reported recently.So it is hopeful that the prognosis of MODS is improved by CRRT.Recently,the effect of CRRT on pre-inflammatory mediators is focused on,but the results are controversial.There were little reports about the effect of CRRT on anti-inflammatory mediators .The relation between the inflammatory mediators clearance and the clinical improvements by CRRT was little reported.Objective: To study the treatment effect of continuous veno-venous hemofiltration on MODS patients and the effect on serum TNF-α,IL-10 and NO in MODS patients.Methods: 41 MODS patients were treated by CVVH. ①The concentrations of TNF-α,IL-10 in serum,ultrafiltrate weremeasured 0,1,12,and the end of CVVH by ELISA, the concentration of NO was measured by nitrate reductase method. ②Clinical variables were observed as follows:renal function, partial pressure of arterial oxygen, arterial oxygen saturation and temperature,heart rate,respiratory rate,mean arterial pressure,et al.Results: ①Clinical improvements during CVVH were impressive in our patients.Temperature was reduced to normality;mean arterial pressure was increased significantly.Heart rate and respiratory rate were also reduced significantly.②CVVH can improve renal function significantly, and increase partial pressure of arterial oxygen and arterial oxygen saturation of MODS patients significantly.③The concentrations of TNF-αand IL-10 in peripheral blood increased significantly after CVVH.The concentration of NO decreased significantly after CVVH.There was no TNF-αin ultrafiltrate;IL-10 was detected little and NO was detected much in ultrafiltate.Compared with prefilter,the concentration of TNF-αin postfilter blood decreased significantly at 1h of CVVH and increased at the end of CVVH. Compared with prefilter,the concentration of NO in postfilter blood decreased significantly at 1h ,12h and the end of CVVH.④CVVH may increase the predominance of anti-inflammatory cytokine(IL-10) over pro-inflammatory cytokine(TNF-α). ⑤There was a negative line-correlation between theconcentration of pre-filter blood NO and mean arterial pressure.Partial pressure of arterial oxygen was also related with the concentration of pre-filter blood NO negatively. Conclusion: ①CVVH may improve the clinical symptoms and organ function in MODS patients.②CVVH was effective in removing TNF-α and NO.TNF-αwas removed mainly by adsorption and NO mainly by convective transport .There was no effect of CVVH on IL-10.③The clearance of NO by CVVH might be one of the mechanisms for the improvement of circulatory and respiratory function.