Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock

何盛琴; 熊建琼; 屈纪富; 张雷; 王涛; 张永辉; 张彦; 陈琨

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Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock

更新时间：2026-01-09

- Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock
- Journal of Army Medical University Vol. 33, Issue 10, Pages: 1061-1064(2011)
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  CLC： R631.4;R459.5;R365
- Published：2011
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何盛琴,熊建琼,屈纪富,张雷,王涛,张永辉,张彦,陈琨.血液净化对脓毒性休克患者血清细胞因子及预后的影响[J].陆军军医大学学报(原第三军医大学学报),2011,33(10):1061-1064.

　He Shengqin,Xiong Jianqiong,Qu Jifu,Zhang Lei,Wang Tao,Zhang Yonghui,Zhang Yan,Chen Kun.Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock[J].J Amry Med Univ (J Third Mil Med Univ),2011,33(10):1061-1064.
何盛琴,熊建琼,屈纪富,张雷,王涛,张永辉,张彦,陈琨.血液净化对脓毒性休克患者血清细胞因子及预后的影响[J].陆军军医大学学报(原第三军医大学学报),2011,33(10):1061-1064. DOI：

　He Shengqin,Xiong Jianqiong,Qu Jifu,Zhang Lei,Wang Tao,Zhang Yonghui,Zhang Yan,Chen Kun.Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock[J].J Amry Med Univ (J Third Mil Med Univ),2011,33(10):1061-1064. DOI：

摘要

目的研究不同血液净化方式对脓毒性休克患者血清细胞因子水平及预后的影响，探讨血液净化对脓毒性休克患者的治疗作用。方法将36例急性生理及慢性健康评分Ⅱ（APACHE Ⅱ评分）≥15分的脓毒性休克患者，采用随机数字表法分为对照组、连续性静脉－静脉血液滤过（continuous veno-venous hemofiltration，CVVH）组、血液灌流（hemoperfusion

HP）+连续性静脉－静脉血液滤过组（HP+CVVH），每组12例，分别进行常规治疗、常规治疗+CVVH治疗、常规治疗+HP+CVVH治疗。检测各组治疗后不同时相点血清TNF-α、IL-6、IL-10、HMGB-1浓度，并比较各组1～7 d全身性感染相关性器官功能衰竭评价（sepsis related organ failure assessment，SOFA）评分及28 d存活率的差别。结果对照组及CVVH组TNF-α、IL-6、HMGB-1、IL-10在第1、3天各时相点浓度变化均无统计学意义（P0.05）；HP+CVVH组中HP治疗2 h后的TNF-α、HMGB-1、IL-10均有明显下降，IL-6也有一定下降，其他时相点浓度变化均无统计学意义（P0.05）。与对照组相比，CVVH组从第4天起SOFA评分即明显降低（P0.05)，HP+CVVH组第2天起SOFA评分即明显降低(P0.05)；28 d存活率提高（对照组、CVVH组、HP+CVVH组分别为41.67%、58.33%、66.67%），且以HP+CVVH组更明显，但3组间无统计学意义。结论 CVVH对脓毒性休克患者血清TNF-α、IL-6、HMGB-1、IL-10的水平无明显影响，HP能显著降低血清TNF-α、HMGB-1、IL-10浓度； CVVH及HP+CVVH治疗均能促进脓毒性休克患者器官功能恢复，且以HP+CVVH治疗效果更佳。

Abstract

Objective To investigate the influence of different blood purification methods on serum cytokine levels and prognosis in patients with septic shock

and to study the therapeutic effects of different blood purification methods on the patients. Methods Thirty-six septic shock patients with acute physiology and chronic health evaluation II (APACHEII) scores not smaller than 15 were randomly divided into a control group (C group)

a continuous veno-venous hemofiltration group (CVVH group)

and a hemoperfusion and continuous veno-venous hemofiltration group (HP+CVVH group). The C group underwent conventional therapy. The CVVH group underwent conventional therapy and CVVH therapy. The HP+CVVH group underwent conventional therapy

HP therapy

and CVVH therapy. The levels of serum cytokines including tumor necrosis factor-α (TNF-α)

interleukin-6 (IL-6)

interleukin-10 (IL-10)

and high-mobility group box chromosomal protein-1 (HMGB-1) in each group were measured at different time points after treatment. The survival rates for 28 d and sepsis related organ failure assessment (SOFA) scores at 1 to 7 d of the three groups were compared. Results There was no significant change in the levels of serum TNF-α

IL-6

IL-10

and HMGB-1 at different time points in the first day and the third day in the C group and CVVH group (P0.05). The levels of TNF-α

IL-10

and HMGB-1 significantly decreased 2 h after HP treatment in the HP+CVVH group

and the IL-6 level also decreased. There was no significant difference in the levels of TNF-α

IL-6

IL-10

and HMGB-1 at other times in the HP + CVVH group (P0.05). Compared with the C group

SOFA score started to significantly decrease on the fourth day in the CVVH group (P0.05) and on the second day in the HP+CVVH group (P0.05). The survival rates for 28 d increased in the three groups (41.67% vs 58.33% vs 66.67%)

especially in the HP+CVVH group

without statistical significance among the three groups. Conclusion There is no significant influence of CVVH on the levels of serum TNF-α

IL-6

IL-10

and HMGB-1. HP significantly lowers the levels of serum TNF-α

IL-10

and HMGB-1. Both CVVH therapy and HP+CVVH therapy

especially HP+CVVH therapy

can promote the functional rehabilitation of organs in patients with septic shock.

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Related Institution

Department of Breast and Thyroid Surgery， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Gastroenterology， Chongqing Hechuan District People’s Hospital

School of Medicine， Chongqing University

Chongqing Key Laboratory of Precision Prevention and Treatment for Digestive System Tumors， Department of Gastroenterology， Army Medical Center of PLA/Daping Hospital of Third Military Medical University

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