He Chao-sheng, Shi Wei, Ye Zhi-ming, Liang Xin-ling, Zhang Bin, Liu Shuang-xin, Qin Tie-he
Department of Nephrology, Guangdong People's Hospital, Guangzhou 510080, Guangdong, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 Jan;19(1):47-9.
To evaluate efficacy and safety of coupled plasma filtration adsorption (CPFA) combined with continuous veno-venous hemofiltration (CVVH) for the treatment of multiple organ dysfunction syndrome (MODS) patients with acute liver failure (ALF), and to evaluate the effect of CPFA plus CVVF on inflammatory mediators in these patients.
A total of 38 cases of 11 MODS patients with ALF (male 6, female 5) were treated with CPFA plus CVVH, and the following clinical indicators including changes in mean arterial pressure (MAP), oxygen index (PaO(2)/FiO(2)), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), IL-6, IL-8, biochemical parameters of liver and kidney function, parameters of systemic inflammatory response syndrome (SIRS) score, and acute physiology and chronic health evaluation II (APACHE II) score were determined before and after the treatment. The degree of improvement in clinical symptoms, feasibility, tolerance toward CPFA plus CVVH, therapy-related adverse reactions and security were simultaneously evaluated.
MAP increased by 12 mmHg (1 mmHg=0.133 kPa), and PaO(2)/FiO(2) increased by 40 mmHg after the application of CPFA plus CVVH (both P<0.05), along with significant decrease in TNF-alpha, IL-1 beta, IL-6, IL-8 and markedly lowered levels of serum total bilirubin (IBIL), direct bilirubin (DBIL), blood urea nitrogen (BUN), serum creatinine (SCr) and blood ammonia (all P<0.05). Besides, clinical symptoms, including urinary volume, mental disturbance, jaundice, debility, nausea, vomiting, fever, abdominal distention, anepithymia, and SIRS, APACHE II scores were improved significantly after the CPFA plus CVVH (all P<0.05). No therapy-related adverse reactions, including severe haemorrhage, shock, hypersensitivity, were noted, and patients tolerated well toward CPFA plus CVVH. The total survival rate of patients was 45.5% (5/11 cases) at the end of the treatment.
Our data indicate that CPFA combined with CVVH is an effective and safe method to improve the prognosis of MODS patients with ALF, the mechanism of which may be related to its effective removal of inflammatory cytokines.
评估配对血浆滤过吸附（CPFA）联合连续性静脉-静脉血液滤过（CVVH）治疗急性肝衰竭（ALF）合并多器官功能障碍综合征（MODS）患者的疗效及安全性，并评价CPFA联合CVVH对这些患者炎症介质的影响。
11例ALF合并MODS患者（男6例，女5例）共38例，接受CPFA联合CVVH治疗，测定治疗前后以下临床指标，包括平均动脉压（MAP）、氧合指数（PaO₂/FiO₂）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、IL-6、IL-8、肝肾功能生化参数、全身炎症反应综合征（SIRS）评分参数及急性生理与慢性健康状况评分系统II（APACHE II）评分。同时评估临床症状改善程度、可行性、对CPFA联合CVVH的耐受性、治疗相关不良反应及安全性。
应用CPFA联合CVVH后，MAP升高12 mmHg（1 mmHg = 0.133 kPa），PaO₂/FiO₂升高40 mmHg（均P < 0.05），同时TNF-α、IL-1β、IL-6、IL-8显著降低，血清总胆红素（IBIL）、直接胆红素（DBIL）、血尿素氮（BUN）、血清肌酐（SCr）及血氨水平明显下降（均P < 0.05）。此外，CPFA联合CVVH治疗后，尿量、精神障碍、黄疸、乏力、恶心、呕吐、发热、腹胀、食欲缺乏及SIRS、APACHE II评分等临床症状均显著改善（均P < 0.05）。未观察到包括严重出血、休克、过敏反应等治疗相关不良反应，患者对CPFA联合CVVH耐受性良好。治疗结束时患者总生存率为45.5%（5/11例）。
我们的数据表明，CPFA联合CVVH是改善ALF合并MODS患者预后的一种有效且安全的方法，其机制可能与其有效清除炎症细胞因子有关。
