CONTINUOUS VENOVENOUS HEMOFILTRATION WITH DIALYSIS REMOVES CYTOKINES FROM THE CIRCULATION OF SEPTIC PATIENTS
CONTINUOUS VENOVENOUS HEMOFILTRATION WITH DIALYSIS REMOVES CYTOKINES FROM THE CIRCULATION OF SEPTIC PATIENTS
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DOI：
10.1097/00003246-199304000-00011
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发表时间：
1993-04-01
影响因子：
8.8
通讯作者：
BOYCE, N
中科院分区：
文献类型：
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作者：
BELLOMO, R;TIPPING, P;BOYCE, N
目标.确定连续性静脉-静脉血液滤过联合透析是否导致肿瘤坏死因子-α的提取（TNF-α）和白细胞介素-1 β（IL-1 β），并定量这些细胞因子的清除率和清除率及其对血清细胞因子浓度的影响。设计：脓毒性急性肾功能衰竭患者通过透析连续性静脉-静脉血液滤过提取TNF-α和IL-1 β的前瞻性对照研究。18例脓毒症和急性肾衰竭危重患者。对照组为6例在接受慢性血液透析时发生急性疾病的患者。干预措施：在连续性静脉-静脉血液滤过联合血液透析前采集血液样本。治疗4小时和24小时后同时收集预滤器血液和超渗滤液。测量和主要结果：测量血液和超渗滤液中TNF-α和IL-1 β的浓度。计算其清除率和每日提取量，并与对照组进行比较。TNF-α在66.6%的脓毒性急性肾功能衰竭患者血清样本中检出; IL-1 β在55%的患者血清样本中检出。在连续性静脉-静脉血液滤过和透析期间，TNF-α和IL-1 β均被血液滤过器清除。TNF-α的平均清除率为30.7 L/天（95%置信区间22.4 - 39），每日平均排泄量为14.1 μ g（95%置信区间1.7 - 26.5）。平均IL-1 β清除率为36.1 L/天（95%置信区间为25.4 - 46.8），相当于平均每日IL-1 β排泄1 μ g（95%置信区间为0.9 - 1.1）。在对照患者的血清或超滤液样本中未发现可测量浓度的TNF-α或IL-1 β。结论：这些发现表明，连续静脉-静脉血液滤过联合透析可以清除脓毒症危重患者循环中的TNF-α和IL-1 β。这种细胞因子提取可能被证明有利于减缓脓毒症相关肾衰竭患者的多器官功能障碍进展，这些患者正在接受连续性静脉-静脉血液滤过和透析。现有血液滤过治疗的这一潜在获益支持其优先用于重度脓毒症相关肾衰竭患者。这些观察结果可能会刺激滤膜设计的修改，以寻求特异性地增加各种此类细胞因子从循环中的清除。
Objectives. To determine whether continuous veno-venous hemofiltration with dialysis leads to extraction of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) from the circulation of critically ill patients with sepsis and acute renal failure and to quantitate the clearance and removal rates of these cytokines and their effect on serum cytokine concentrations.Design: Prospective, controlled study of TNF-alpha and IL-1beta extraction by continuous veno-venous hemofiltration with dialysis in patients with septic acute renal failure.Setting: Intensive care unit of a tertiary institution.Patients. Eighteen critically ill patients with sepsis and acute renal failure. Control group of six patients experiencing an acute illness while undergoing chronic hemodialysis.Interventions: Collection of blood samples before continuous veno-venous hemofiltration with hemodialysis. Simultaneous collection of prefilter blood and ultradiafiltrate after 4 and 24 hrs of treatment.Measurements and Main Results: TNF-alpha and IL-1beta concentrations were measured in blood and ultradiafiltrate. Their clearances and daily extraction were calculated and compared with a control group. TNF-alpha was detected in 66.6% of serum samples of patients with septic acute renal failure; IL-1beta was detected in 55% of patients' sera samples. Both TNF-alpha and IL-1beta were cleared by the hemofilter during continuous veno-venous hemofiltration with dialysis. The mean clearance for TNF-alpha was 30.7 L/day (95% confidence interval 22.4 to 39) with a daily mean excretion of 14.1 mug (95% confidence interval 1.7 to 26.5). Mean IL-1beta clearance was 36.1 L/day (95% confidence interval 25.4 to 46.8) equivalent to a mean daily IL-1beta excretion of 1 mug (95% confidence interval 0.9 to 1.1). No measurable concentrations of TNF-alpha or IL-1beta were found in the serum or ultrafiltrate specimens of control patients.Conclusions: These findings demonstrate that continuous veno-venous hemofiltration with dialysis can remove both TNF-alpha and IL-1beta from the circulation of septic, critically ill patients. This cytokine extraction may prove to be of benefit in attenuating the progression of multiple organ dysfunction in patients with sepsis-associated renal failure, who are receiving continuous veno-venous hemofiltration with dialysis. This potential benefit of existing hemofiltration therapies supports their preferential implementation in patients with renal failure associated with severe sepsis. These observations may stimulate the modification of filtration membrane design seeking to specifically augment the clearance from the circulation of a variety of such cytokines.