[The protective effects to the function of kidney and long by clearing of cytokines in patients with open-heart surgery]

Abstract

Objective: To observe the effect of cytokines absorption on renal and respiratory function in patients with open-heart surgery.

Methods: 30 patients undergoing valve replacement with cardiopulmonary bypass (CPB) were randomly divided into two groups. A sulfonated polyacrylonitrile hemofilter (AN69) that has been used to absorb cytokines was connected into the efferent limb of CPB in Group A (n = 15), and a cellulose triacetate hemofilter (CT 190G) instead of AN69 was used as controls (Group B, n = 15). The levels of plasma pro-inflammatory (TNF-alpha, IL-6, IL-8) anti-inflammatory cytokines (IL-10, IL-1ra), C-reactive protein (CRP) levels, and post-operation renal and respiratory function were compared between the two groups. Blood samples were analysed for TNF-alpha and IL-6 and IL-8 and C-reactive protein (CRP). The changes in renal, respiratory function were also observed.

Results: (1) At the end of CPB, TNF-alpha 10 ng/L +/- 3 ng/L and IL-6 115 ng/L +/- 22 ng/L levels in Group A were significantly lower than that in Group B 13 ng/L +/- 3 ng/L, 134 ng/L +/- 29 ng/L) respectively (P < 0.05 in all). There is no statistical differences in plasma IL-10 and IL-1ra levels between the two groups. (2) After 24 hours of CPB, the magnitude of increased body temperature, heart rate, white blood cell and plasma CRP in Group A [1.6 degrees C +/- 0.2 degrees C, 15/min +/- 4/min, (17 +/- 3) x 10(9)/L, 56 mg/L +/- 13 mg/L], were significantly lower than that in Group B [2.1 degrees C +/- 0.2 degrees C, 23/min +/- 6/min, (22 +/- 3) x 10(9)/L, 69 mg/L +/- 15 mg/L] respectively (P < 0.05 in all). (3) After 24 hours of CPB, the levels of 24h urinary protein excretion and urinary N-acetyl-beta-D-glucosaminidase (NAG) were significantly lower in Group A when compared to that in Controls (0.20 g/d +/- 0.08 g/d vs 0.30 g/d +/- 0.14 g/d, 28 U/L +/- 11 U/L vs 38 U/L +/- 13 U/L respectively), P < 0.05 in all. The level of creatinine clearance (Ccr) in Group A (68 +/- 7) ml.min(-1).1.73 m(-2) was significantly elevated than that in Group B (57 +/- 11) ml.min(-1).1.73 m(-2) (P < 0.05). (4) One hour after the end of CPB, the magnitude of increased plateau airway pressure (P(Plateau)) and peak airway pressure (P(Peak)) in Group A were significantly lower than that in Controls (P < 0.01 in all). The duration that need mechanical ventilation after operation in Group A (4.9 h +/- 0.6 h) was much shorter than that in Group B (5.8 h +/- 0.8 h, P < 0.05).

Conclusions: Lowering the plasma levels of cytokines by extracorporeal absorption may attenuate systemic inflammatory response and protect lung and kidney function in patients with open-heart surgery.