在脓毒症和急性肾损伤患者中使用高通量血液滤过器进行连续静脉-静脉血液透析时降钙素原和选定细胞因子的清除。
Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury.
机构信息
Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
Department of Laboratory Diagnostics, Military Institute of Medicine, Warsaw, Poland.
出版信息
Blood Purif. 2018;46(2):153-159. doi: 10.1159/000488929. Epub 2018 Apr 27.
INTRODUCTION
The purpose of this study was to evaluate the impact of continuous veno-venous hemodialysis (CVVHD) using high cutoff (HCO) hemofilters on the removal of procalcitonin (PCT), and other inflammatory markers in the treatment of patients during septic shock with acute kidney injury (AKI).
MATERIALS AND METHODS
Thirty-six patients with septic shock and AKI were included in the study. Before and after the 24-h HCO-CVVHD, PCT, native C-reactive protein (CRP) and cytokines (interleukin-1β, interleukin-6, interleukin-12, interleukin-17, tumor necrosis factor-α) in serum and effluent were assessed.
RESULTS
After the HCO-CVVHD serum concentrations of PCT, CRP and selected cytokines were significantly lower. The decrease in PCT was bigger than in CRP (p = 0.007). The change in PCT concentration was significantly influenced by PCT and IL-17 clearances (R2 = 0.525; p < 0.001).
CONCLUSION
In contrast to the native CRP, monitoring of PCT during HCO-CVVHD is less useful because it reflects the clearance of this marker and anti-inflammatory effectiveness of the method.
简介
本研究旨在评估使用高通量（HCO）血液滤器进行连续静脉-静脉血液透析（CVVHD）对脓毒性休克合并急性肾损伤（AKI）患者治疗中降钙素原（PCT）和其他炎症标志物清除的影响。
材料和方法
本研究纳入了 36 例脓毒性休克合并 AKI 患者。在 24 小时 HCO-CVVHD 前后，评估了血清和流出液中 PCT、天然 C 反应蛋白（CRP）和细胞因子（白细胞介素-1β、白细胞介素-6、白细胞介素-12、白细胞介素-17、肿瘤坏死因子-α）的水平。
结果
HCO-CVVHD 后，血清 PCT、CRP 和选定细胞因子的浓度显著降低。与 CRP 相比，PCT 的下降幅度更大（p = 0.007）。PCT 浓度的变化与 PCT 和 IL-17 的清除率显著相关（R2 = 0.525；p < 0.001）。
结论
与天然 CRP 相比，在 HCO-CVVHD 期间监测 PCT 的意义不大，因为它反映了该标志物的清除率和方法的抗炎效果。
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