The effect of blood purification on removing plasma inflammatory mediators in HFRS patients

Objective: To observe the removal of tumor necrosis factor- α (TNF- α), interleukin-6 (IL-6) and endothelin-1 (ET-1) in continuous renal replacement therapy (CRRT) on hemorrhagic fever with renal syndrome (HFRS) patients, and investigate the effect of inflammatory mediators on HFRS. Methods: A total of 40 patients with moderate or more severe HFRS were divided into two groups randomly. Continuous venous-venous hemofiltration (CVVH) was applied to the 20 cases in CVVH group, and hemodialysis (HD) was applied to the 20 cases in HD group. The levels of TNF- α and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA), and ET-1 level was measured by radioimmunoassays (RIA). Results: Circled digit one In comparing CVVH and HD groups, the days of oliguria (3.0 ± 2.1, 6.0 ± 3.4), incidence of complications (25%, 40%), and mortality (15%, 25%) had significant differences (P<0.01). Circled digit two The decrease of plasma BUN and Cr had significant differences before and after treatment in both CVVH and HD groups (P<0.01). Circled digit three In CVVH group, the plasma levels of TNF- α, IL-6 and ET-1 decreased markedly after treatment in comparison with those before treatment, with significant differences (P<0.05). In contrast, the levels of TNF- α, IL-6 and ET-1 in HD group did not significantly differ before and after treatment (P>0.05). Circled digit four In CVVH group, IL-6 and ET-1 could be detected constantly in filtrate, but TNF- α was not detectable. TNF- α, IL-6 and ET-1 were not detectable in dialysate. Conclusion: Continuous blood purification can remove plasma inflammatory mediators. Therefore, it is helpful in recovering renal function, improving the prognosis of HFRS, and decreasing complications and mortality. CVVH is one of the best methods to treat HFRS.