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Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock

He Shengqin,Xiong Jianqiong,Qu Jifu,Zhang Lei,Wang Tao,Zhang Yonghui,Zhang Yan,Chen Kun(Department of Emergency,Southwest Hospital,Third Military Medical University,Chongqing,400038,China)  
Objective To investigate the influence of different blood purification methods on serum cytokine levels and prognosis in patients with septic shock,and to study the therapeutic effects of different blood purification methods on the patients.Methods Thirty-six septic shock patients with acute physiology and chronic health evaluation II(APACHEII) scores not smaller than 15 were randomly divided into a control group(C group),a continuous veno-venous hemofiltration group(CVVH group),and a hemoperfusion and continuous veno-venous hemofiltration group(HP+CVVH group).The C group underwent conventional therapy.The CVVH group underwent conventional therapy and CVVH therapy.The HP+CVVH group underwent conventional therapy,HP therapy,and CVVH therapy.The levels of serum cytokines including tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10),and high-mobility group box chromosomal protein-1(HMGB-1) in each group were measured at different time points after treatment.The survival rates for 28 d and sepsis related organ failure assessment(SOFA) scores at 1 to 7 d of the three groups were compared.Results There was no significant change in the levels of serum TNF-α,IL-6,IL-10,and HMGB-1 at different time points in the first day and the third day in the C group and CVVH group(P0.05).The levels of TNF-α,IL-10,and HMGB-1 significantly decreased 2 h after HP treatment in the HP+CVVH group,and the IL-6 level also decreased.There was no significant difference in the levels of TNF-α,IL-6,IL-10,and HMGB-1 at other times in the HP + CVVH group(P0.05).Compared with the C group,SOFA score started to significantly decrease on the fourth day in the CVVH group(P0.05) and on the second day in the HP+CVVH group(P0.05).The survival rates for 28 d increased in the three groups(41.67% vs 58.33% vs 66.67%),especially in the HP+CVVH group,without statistical significance among the three groups.Conclusion There is no significant influence of CVVH on the levels of serum TNF-α,IL-6,IL-10,and HMGB-1.HP significantly lowers the levels of serum TNF-α,IL-10,and HMGB-1.Both CVVH therapy and HP+CVVH therapy,especially HP+CVVH therapy,can promote the functional rehabilitation of organs in patients with septic shock.
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