Effect Of Continuous Blood Purification On The Serum Levels Of PCT And Cytokines Of TNF-aIL-6 IL-10 In Patients With Systemic Inflammatory Response Syndrome Or Sepsis And Acute Renal Failure

Objective:to investigate the effect of continuous blood purification(CBP) on the clearance of serum PCT and TNF-αIL-6 IL-10;and the diagnostic value of PCT in patients with sepsis;meanwhile to observe the benefit of renal function, hemodynamic and prognosis of patients with systemic inflammatory response syndrome(SIRS) or sepsis and acute renal failure (ARF) .Methods:Eighteen patients with SIRS or Sepsis and ARF in Intensive care unit of ous hospital were scheduled for treatment of CBP.Ten of these patients are male,Eight are female.Mean age was 59.8士20.9 years old. All patients were satisfied criteria of SIRS or Sepsis and ARF .Except for routine monitors,heart rate(HR),respiration(R),blood pressure(BP)and the central venous Pressure(CVP)wasmonitored.Adouble trunk catheter was put into right femoral vein and CBP was done with the ADM08/ABM CRRT.The replacement liquid was put in by the pattern of pre-dilution.The flow was from 3.0ml to4.0ml per hour.The blood flow was from 200ml to 300ml per minuter.The volume of ultrafiltration depended on the volume of treatment and the volume of physiological need.Treatments included the manegement of primary disease and maintenance of main organ and system function.The T,HRR,BP,CVP and blood biochemical markers including electrolytes,ureanitrogen and creatine,serum PCT ,cytokines and arterial blood gas were recorded and measured at 0h 2h 6h 12h following CBP and 12h post-CBP。The concentration of serum PCT and cytokines was measured by ELISA.Results:The initial concentration of serum PCT was 0.68士0.21ng/L in Patients with SIRS and 1.73士0.79 ng/L in patients with sepsis.There was remarkable difference in two group. The serum levels of PCT begain to decrease at 2h following CBP,the minimum was 0.92士0.60ng/L at 6h following CBP,then increased,but was lower than those pre-CBP and there was no significant difference compared with those pre-CBP. The serum concentrations of TNF-a decreased markedly at 2h,6h and 12h following CBP , the minimum was 60.16士9.06ng/L at 6h ,the serum levels of TNF-a increased at 12h post-CBP, but was still lower than that before CBP. There was no significant difference in the serum concentration of IL-6 and IL-10 at any time following CBP and post-CBP compared with those before CBP,although those of the reduced gradually following CBP. No significant difference was found in the parameters of hemodynamics except for HR significant decrease following CBP,There was also no significant difference in blood Na+,Cl-,Glu, pH, PaC02 after CBP compared with those pre-CBP.Conclusions:CBP could remove PCT in serum;The level of serum PCT is regarded as one of diagnostic index for the patients withSepsis;meanwhile CBP could also remove many inflammatorycytokines,and improve blood biochemical markers includingBUN,Scr,and serum K+ with little harmful effect onhemodynamics in patients with SIRS or Sepsis and ARF.