Hirano Takeshi, Hirasawa Hiroyuki, Oda Shigeto, Shiga Hidetoshi, Nakanishi Kazuya, Matsuda Ken-Ichi, Nakamura Masataka, Asai Takayoshi, Kitamura Nobuya
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Blood Purif. 2004;22(2):188-97. doi: 10.1159/000076852.
Delay of polymorphonuclear leukocyte (PMN) apoptosis caused by hypercytokinemia is considered to be a potential cause of tissue damage and resultant organ failure. We evaluated whether continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF), which can remove cytokines in the circulating blood, can modulate apoptosis in peripheral blood neutrophils and thereby reduce tissue damage and organ dysfunction in 25 critically ill patients. Following the completion of a 3-day PMMA-CHDF session, serum cytokine levels were significantly decreased and the percentage of apoptotic PMNs was significantly increased. A significant correlation was observed between the PMMA-CHDF-induced increase in the percentage of apoptotic PMNs and the degree of decrease in the serum interleukin-6 level. A significant correlation was also found between the increase in the percentage of apoptotic PMNs and improvement in sequential organ failure assessment score following PMMA-CHDF. These results suggest that PMMA-CHDF in critically ill patients with hypercytokinemia and concomitant delay in apoptosis of PMNs can alleviate the delay of PMN apoptosis through the removal of serum cytokines and thus may result in avoidance of organ dysfunction.
高细胞因子血症导致的多形核白细胞（PMN）凋亡延迟被认为是组织损伤及由此导致器官衰竭的一个潜在原因。我们评估了使用能清除循环血液中细胞因子的聚甲基丙烯酸甲酯膜血液滤过器进行连续性血液透析滤过（PMMA-CHDF），是否能调节外周血中性粒细胞的凋亡，从而减少25例危重症患者的组织损伤和器官功能障碍。在完成为期3天的PMMA-CHDF治疗后，血清细胞因子水平显著降低，凋亡PMN的百分比显著增加。观察到PMMA-CHDF诱导的凋亡PMN百分比增加与血清白细胞介素-6水平降低程度之间存在显著相关性。在PMMA-CHDF后，凋亡PMN百分比的增加与序贯器官衰竭评估评分的改善之间也发现存在显著相关性。这些结果表明，对于伴有高细胞因子血症和PMN凋亡延迟的危重症患者，PMMA-CHDF可通过清除血清细胞因子减轻PMN凋亡延迟，从而可能避免器官功能障碍。
