| Acute kidney injury (AKI) is a common disease in ICU ward. Toxic shock and thereby lead to kidney damage which caused by a severe infection/endotoxemia has become one of important reasons of acute renal injury, and concurrent cardiovascular system organ dysfunction is the main reason leading to the mortality in patients with acute renal injury continuou increase, about 4% of the patients need renal replacement therapy (RRT) [1]. Continuous renal replacement therapy (CRRT) as a new blood purification technology, remove water and solute slowly, continuously, so that patients with stable hemodynamics, can sustained and stabled control of azotemia and electrolyte and water salt metabolism, and constantly remove the toxins and molecular substances in the presence of circulation,and supply on-demand nutritional for the treatment of critically ill patients,provides survival within the steady-state balance, even can be applied under conditions of low blood pressure. They are usually more widely used than intermittent renal replacement therapy (IRRT) in the treatment of critically ill patients . Continuous veno-venous hemofiltration (CVVH) is a kind of CRRT,can better maintain hemodynamic stability, to correct electrolyte imbalance, maintaining acid-base balance, removing inflammatory mediators to maintain a stable internal environment.Blood circulating endothelial cells (CECs) in patients with acute renal injury in inflammatory, immune response, infections, cardiovascular diseases are closely related. In the clinical, pathological and laboratory studies show that a variety of blood vessels and micro-inflammatory state is vasculitis, in early injury, the number of endothelial cells in inflammation and disease activity and severity of related, therefore, significant changes in their number could be As disease activity and severity of the direct detection of early indicators . Toll-like receptor 4 (Toll like receptor 4, TLR4) as the earliest discovered Toll-like receptor (TLR) subtype is one of the natural immune system to identify the main pathogenic microorganisms receptors. In the natural immune response, identifying bacterial lipopolysaccharide (lipopolysaccharide, LPS) and its mediated signal transduction in the inflammatory response has an important role in infectious diseases and has also been extensive attention. TLR4 as a transmembrane receptor that can mediate a variety of important pathogens in composition and cell response, by starting the cellular immune and inflammatory responses, in the pathophysiology of sepsis plays an important role in the process, thereby inducing acute kidney injury place. Circulating endothelial cells and Toll-like receptor 4 are reflected in indicators of inflammation, so this experiment observed the continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) in patients with peripheral blood circulating endothelial cells (CECs) and the levels of TLR4 and You implications for clinical treatment of AKI combined SIRS and provide a theoretical basis and experimental evidence.In this study, we detected acute kidney injury (AKI) in patients with flow cytometry before and after continuous renal replacement therapy (CRRT) in peripheral blood circulating endothelial cells (CECs) and TLR4 levels in a clear CRRT for AKI in patients with circulating endothelial cells (CECs), and TLR4 levels in analysis CRRT in acute renal injury in patients with severe infection in the role.In this study, patients received hospital stay and the diagnosis of acute kidney injury (AKI) and multiple organ failure patients, are all consistent with the 2005 Amsterdam Conference on the standard,and then divided according to diagnostic criteria of SIRS group and non-severe infection of severe infection group.13 males,7 females; aged 19-74 years old, with a median age of 45 years. Severe infection group,9 persons, non-severe infection group,11 were normal control group 10.1 case of colon cancer surgery, solitary kidney after one cases of bladder cancer, lupus nephritis,5 cases of primary nephrotic syndrome MODS4 cases, CO poisoning,1 case of acute necrotizing pancreatitis in 2 cases,3 cases of severe biliary tract infection, nephrotic syndrome,3 cases of pulmonary embolism.20 cases were taken to bedside CVVH treatment, was taken before and after treatment 100uL anticoagulant (EDTA-K2 anticoagulant) were placed in two 12nlmX 75 mm test tube, were added to 20uLCD31 a FITC/TLR4 a PE and a FITC same type of control IgG1/ IgGl a PE, mixing dark, after 20min, with the Q-PREP hemolysis hemolytic instrument, the machine detected. Pre-test standard fluorescent microsphere Flow-check. Calibration FL1, FL2, FL4, and SS, FS-channel accuracy, so that each channel CV<2%, specimens collected by the data used Expo32ADC analysis. Experimental results are mean±standard deviation (χ±s) that the use of statistical software SPSS 16.0 multivariate analysis of variance, P<0.05 was considered significant difference.Results:1. The expression in peripheral blood of AKI patients is more than the normal control group (23.18±2.21) vs (12.96±1.45), combined with severe infection, expression was significantly higher (33.44±2.81) vs (12.96±1.45), after 12-24 hour CVVH treatment, CECs to reduce the expression of both is still higher than the normal control group (20.64±1.91) vs (12.96±1.45), (P<0.05); 2. The expression of TLR4 in peripheral blood of AKI patients than the normal control group (17.48±2.76) vs (10.53±0.88), combined with severe infection, expression was significantly higher (22.64±2.18) vs (10.53±0.88), after CVVH treatment later, TLR4 expression in both lower still higher than the normal control group (13.18±1.68) vs (10.53±0.88), (P＜0.05).Conclution:CRRT can reduce the grain of peripheral mononuclear cells in the expression of circulating endothelial cells, through the gradual removal of endotoxin reduced TLR4 expression in vivo in patients with AKI to improve the micro-inflammatory state and improve the internal environment, promote functional recovery of organs and improve survival.
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