[Effect of hemofiltration combined with hemoabsorption on improvement of immune function in septic patients with low expression of human leukocyte antigen DR].

OBJECTIVE

To investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.

METHODS

A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous venovenous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluation II (APACHE II) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.

RESULTS

The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9 ± 7.3)% vs. (26.4 ± 6.7)%, P > 0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9 ± 8.6)% vs. (29.3 ± 7.1)%, 5 days: (42.7 ± 9.2)% vs. (31.4 ± 6.5)%, 7 days: (40.9 ± 8.5)% vs. (29.4 ± 6.7)%, all P < 0.05]. There was no significant difference in APACHE II score before treatment between experimental group and control group (22.4 ± 5.3 vs. 21.7 ± 6.2, P > 0.05). APACHE II score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6 ± 3.6 vs. 20.5 ± 4.3, 5 days: 15.8 ± 3.9 vs. 21.1 ± 4.4, 7 days: 14.9 ± 4.2 vs. 19.8 ± 3.7, all P < 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3 ± 3.4 vs. 19.8 ± 3.7, t = 6.432, P = 0.003) and length of ICU stay (days: 20.7 ± 3.9 vs. 26.8 ± 4.7, t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%, χ2 = 3.121, P = 0.016).

CONCLUSION

Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.