Jin Zhao-chen, Yu Zhi-xin, Ji Mu-sen, Zhou Hong
Intensive Care Unit, People's Hospital of Zhenjiang City Affiliated to Jiangsu University, Zhenjiang 212002, China.
Zhonghua Yi Xue Za Zhi. 2008 Aug 19;88(32):2274-7.
To investigate the changes of interleukin (IL)-6 serum level in patients with acute respiratory distress syndrome (ARDS) and the effects of continuous renal replacement therapy (CRRT) on IL-6 level and its clinical significance.
Forty ARDS patients were randomly divided into 2 equal groups: Group A undergoing conventional treatment and Group B receiving conventional treatment plus CRRT at onset of ARDS. Serum IL-6 level was measured by enzyme linked immunosorbent assay (ELISA) at the onset (0 h) and 12, 24, 48, and 72 hours later. Dynamic APACHEII score was also evaluated at the time points of 0, 24, 48, and 72 h. The incidence of ventilator-associated pneumonia (VAP), intensive care unit (ICU) mortality rate, duration of total mechanical ventilation, and ICU stay were assessed. Twenty-five healthy examinees were used as controls.
The serum IL-6 level of the whole ARDS patients was significantly higher then that of the normal controls (P < 0.01), and the serum IL-6 level of the ARDS patients who died was significantly higher than that of the ARDS patients who survived (P < 0.01). The IL-6 serum level was correlated well with the APACHEIIscore either in the survival subgroup or the non-survival subgroup (for the former: r = 0.560 P = 0.008, and for the latter: r = 0.518 P = 0.023). Group B, contrary to Group A, had persistently decreased serum IL-6 levels and APACHEII scores at the onset and during the progression of ARDS (all P < 0.05). The incidence of VAP in Group B was 45%, significantly lower than that in Group A (80%, P = 0.022) while the ICU mortality rate didn't differ between the two groups (40% vs 55%, P = 0.342). The duration of total mechanical ventilation and ICU stay of the Group B patients who underwent early CRRT were (12 +/- 5) days and (16 +/- 5) days respectively, both significantly shorter than those of Group A patients [(16 +/- 5) days, P = 0.027 and (19 +/- 5) days, P = 0.030].
The elevated serum IL-6 level in ARDS patients seems to be correlated well with the severity of lung injury, and appears to be a good marker to judge the prognosis of the disease combined with APACHEII score. In the early phase of ARDS, CRRT can decrease the high serum level of IL-6, shorten the duration of total mechanical ventilation and ICU stay, and decrease the incidence of VAP. Removal of the circulating proinflammatory cytokines by CRRT may be one of the most vital mechanisms to treat ARDS.
探讨急性呼吸窘迫综合征（ARDS）患者血清白细胞介素（IL）-6水平的变化以及持续肾脏替代治疗（CRRT）对IL-6水平的影响及其临床意义。
40例ARDS患者随机分为两组，每组20例：A组接受常规治疗，B组在ARDS发病时接受常规治疗加CRRT。在发病时（0小时）及之后12、24、48和72小时，采用酶联免疫吸附测定（ELISA）法检测血清IL-6水平。在0、24、48和72小时时间点评估动态急性生理与慢性健康状况评分系统II（APACHEII）评分。评估呼吸机相关性肺炎（VAP）的发生率、重症监护病房（ICU）死亡率、总机械通气时间和ICU住院时间。选取25名健康体检者作为对照。
ARDS患者的血清IL-6水平显著高于正常对照组（P < 0.01），死亡的ARDS患者血清IL-6水平显著高于存活的ARDS患者（P < 0.01）。在存活亚组和非存活亚组中，IL-6血清水平与APACHEII评分均具有良好的相关性（前者：r = 0.560，P = 0.008；后者：r = 0.518，P = 0.023）。与A组相反，B组在ARDS发病时及病程中血清IL-6水平和APACHEII评分持续下降（均P < 0.05）。B组VAP发生率为45%，显著低于A组（80%，P = 0.022），而两组ICU死亡率无差异（40%对55%，P = 0.342）。早期接受CRRT的B组患者总机械通气时间和ICU住院时间分别为（12±5）天和（16±5）天，均显著短于A组患者[（16±5）天，P = 0.027；（19±5）天，P = 0.030]。
ARDS患者血清IL-6水平升高似乎与肺损伤严重程度密切相关，结合APACHEII评分似乎是判断疾病预后的良好指标。在ARDS早期，CRRT可降低血清IL-6高水平，缩短总机械通气时间和ICU住院时间，并降低VAP发生率。CRRT清除循环中的促炎细胞因子可能是治疗ARDS的关键机制之一。
