| Improvement of monocyte function and immune homeostasis by high volume continuous venovenous hemofiltration in patients with severe acute pancreatitis. | |
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MedLine Citation:
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PMID: 19009506 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Continuous renal replacement therapy (CRRT) showed promising results in the management of critically ill patients with systemic inflammatory response syndrome (SIRS)/sepsis. However, the underlying mechanism is still not very clear. A change of immune homeostasis in critically ill patients during CRRT was observed only to a smaller degree. OBJECTIVE: The purpose of this study was to test the hypothesis that high-volume continuous venovenous hemofiltration (HV-CVVH) treatment could improve monocyte function and restore immune homeostasis in patients with severe acute pancreatitis (SAP). METHODS: This was a prospective clinical trial in the surgical intensive care unit of a teaching hospital. Subjects were 16 patients with severe acute pancreatitis: sepsis group (n=7): positive culture result and in the late phase of disease (from onset of SAP to receiving CVVH therapy: more than 3 days); and nonseptic group (n=9): negative culture result and early phase of disease (less than 3 days). Patients received 72 hours of HV-CVVH. We measured the change in mean arterial pressure, APACHE II score, monocyte functions (including antigen-presenting and cytokine production ability), and plasma cytokines. RESULTS: Mean arterial pressure were stable accompanied with APACHE II score improvements. HLA-DR expression on monocytes (antigen-presenting ability) were markedly decreased (p<0.0001) in all patients. Lipopolysaccharide (LPS)-induced TNF-alpha, interleukin-6 (IL-6), and IL-10 production from patients' monocytes markedly decreased in septic patients, but significantly increased in nonseptic patients. During HV-CVVH treatment, HLA-DR expression was markedly increased in nonseptic patients in 24 hours (p<0.05), and in septic patients in 72 hours (p<0.05). LPS-induced cytokine production was decreased in nonseptic patients, but not significantly changed in septic patients. The change of plasma cytokines showed the same trend. CONCLUSIONS: In patients with SAP, HV-CVVH was associated with improved hemodynamics. HV-CVVH restores monocytes functions, especially in patients in the early phase of the disease and without sepsis. These findings suggest a potential role for HV-CVVH in the treatment of SAP. |
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Authors:
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C Yu; Z-H Liu; Z-H Chen; D H Gong; D-X Ji; L S H Li |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The International journal of artificial organs Volume: 31 ISSN: 0391-3988 ISO Abbreviation: Int J Artif Organs Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-11-14 Completed Date: 2009-02-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802649 Medline TA: Int J Artif Organs Country: Italy |
Other Details:
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Languages: eng Pagination: 882-90 Citation Subset: IM |
Affiliation:
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Department of Nephrology, East Hospital, Tongji University School of Medicine, Shanghai - PR China. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged, 80 and over Female HLA-DR Antigens / blood Hemofiltration / methods* Homeostasis Humans Immune System / physiology Interleukin-10 / blood Interleukin-6 / blood Male Middle Aged Monocytes / physiology* Pancreatitis / blood, immunology, therapy* Prospective Studies Renal Replacement Therapy* Tumor Necrosis Factor-alpha / blood |
| Chemical | |
Reg. No./Substance:
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0/HLA-DR Antigens; 0/Interleukin-6; 0/Tumor Necrosis Factor-alpha; 130068-27-8/Interleukin-10 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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