The Effect And Clinical Significance Of Continuous Renal Replacement Therapy On HMGB1 In Patients With Sepsis In Patients With Sepsis

Objective:In this study,we monitored the effects of continuous continuous renal replacement therapy on infection-related indicators(WBC,NE,PCT)and high-mobility group protein B1(HMGB1)[1]expression levels in sepsis patients.To explore the effect of CRRT treatment on the therapeutic effcacy and prognosis of sepsis patients and the clearance effect of HMGB1 on sepsis patients.Methods:A total of 79 patients with sepsis admitted to the Department of Intensive Medicine of the Fourth Affiliated Hospital of Kunming Medical University from January 2019 to November 2019 were selected.All enrolled patients are in accordance with Sepsis 3.0 diagnostic criteria[2].The international guidelines for the management of sepsis and septic shock in 2016[3]standard for routine treatment,the experiment is divided into three groups,according to whether CRRT treatment is divided into conventional treatment group(40 cases)and CRRT treatment group(39 cases),CVVHDF treatment mode was used for CRRT treatment.At the same time,42 healthy volunteers were selected as blank control group as the baseline level of serum HMGB1 expression.Comparison of patients in the conventional treatment group and the CRRT treatment group:(1)General clinical characteristics:age,gender,acute physiology and chronic health evaluation(APACHE ?)score,body temperature,heart rate,etc.;(2)infection indicators before and after treatment:white blood cell count(WBC),neutrophilic granululocyte(NE),and procalcitonin(PCT);(3)Enzyme linked immunosorbent assay(ELISA)to determine sepsis HMGB1 expression levels in serum and CRRT filtered waste fluid at different treatment time points in patients'serum and CRRT filtered waste fluid(0ht,6h,12h,24h,48h,72h after treatment);(4)routine analysis Correlation between serum HMGB1 expression level and WBC,PCT,APACHE ? scores in treatment group and CRRT treatment group;(5)and temperature,heart rate,WBC,NE,PCT at corresponding time points and APACHE II scores were evaluated to evaluate clinical outcome:hospital Time,total hospitalization cost,28-day mortality and draw survival curves.One-Way ANOVA was used for comparison between groups within and among the experimental groups,t test was used for two independent samples,and Pearson's method was used for correlation analysis of each index.The difference was statistically significant at P<0.05.Results:(1)General clinical features:The sepsis patients included in the study met the diagnostic criteria of Sepsis 3.0,a total of 79 cases,including 40 cases in the conventional treatment group,12 deaths,39 cases in the CRRT treatment group,and 4 deaths.There was no statistically significant difference between groups in gender composition(P>0.05);there was no statistically significant difference in body temperature and heart rate(P>0.05).After treatment,the temperature and heart rate of CRRT patients at all time points were lower than those in conventional treatment groups,the difference was statistically significant(P<0.05);(2)Infection indicators:There was no statistically significant difference in WBC,NE,PCT between patients in the conventional treatment group and CRRT treatment group(P>0.05).At the time point,WBC,NE,and PCT were all lower than the conventional treatment group,the difference was statistically significant(P<0.05);(4)Disease severity:There was no statistically significant difference in the APACHE ? score between patients in the conventional treatment group and CRRT treatment group(P>0.05),the APACHE ?scores of patients in the CRRT treatment group after treatment were lower than those in the conventional treatment group,the difference was statistically significant(P<0.05);(5)Inflammatory factor HMGB1:the conventional treatment group and CRRT treatment before treatment There was no statistically significant difference in the serum HMGB1 level of patients(P>0.05);the serum HMGB1 level of CRRT patients at each time point after treatment was lower than that of the conventional treatment group,the difference was statistically significant(P<0.05);The HMGB1 expression was detected in the filtered waste liquid at various time points in the treatment group,which may be the highest clearance level at 6h,and stabilized after 24h;(7)serum HMGB1 levels and WBC,PCT,APACHE ? score was positively correlated(P<0.05);(8)Hospitalization and prognosis:the total hospitalization time and 28-day mortality of patients in CRRT treatment group were lower than those in conventional treatment group,the difference was statistically significant(P<0.05).Conclusion:CRRT can effectively clear the serum HMGB1 expression level in ICU sepsis patients,control the body's inflammatory response,improve the infection status indicators of sepsis patients,control the body's inflammation response,maintain hemodynamic stability and improve the prognosis of patients.;At the same time,it can effectively clear the circulating HMGB1 level in patients with sepsis and may reach the maximum clearance efficiency 6h after being on the machine,and curb the progress of the body's inflammatory response.