Change and significance of heparin-binding protein in hemoperfusion(HA380)combined with continuous veno-venous haemofiltration for sepsis
Objective To observe the changes of blood heparin-binding protein(HBP)after hemoperfusion(HA380)combined with continuous veno-venous haemodiafiltration(CVVH)in septic patients,and to explore the significance of HBP in assessing therapeutic effect.Methods Ninety-two septic patients were treated in Jining First People's Hospital from September 2022 to February 2024,and were randomly and equally divided into observation group and control group.Control group received conventional treatment,besides which observation group received continuous blood purification with hemoperfusion(HA380)combined with CVVH for 72 h.Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,mean arterial pressure,and oxygenation index were recorded before and 72 h after treatment.Arterial HBP,procalcitonin,C-reactive protein,lactate,interleukin(IL)-6,IL-8,and IL-10 levels were measured.The reduction rates of SOFA score and HBP level were calculated.Spearman's correlation method was used to analyze the correlation between HBP level and SOFA score,and between HBP level reduction rate and SOFA score reduction rate before and after treatment in two groups.Results The scores of SOFA and APACHE Ⅱ,and the levels of HBP,procalcitonin,C-reactive protein,lactate,IL-6,IL-8 and IL-10 were lower after treatment in observation group[6.39±1.67,11.48±1.81,176.38(154.99,192.27)μg/L,32.07(28.84,36.40)μg/L,125.36(112.87.144.48)mg/L,3.15(2.50,3.50)mmol/L,348.44(123.89,648.86)ng/L,133.47(77.47,248.04)ng/L,76.63(39.14,159.79)ng/L]than those in control group[9.11±2.11,16.30±3.81,254.98(228.48,263.05)μg/L,61.74(48.62,65.67)μg/L,170.36(161.47,183.94)mg/L,3.80(3.30,4.53)mmol/L,456.00(252.35,1 666.37)ng/L,186.90(115.77,498.07)ng/L,141.76(62.04,783.80)ng/L](t=6.854,t=7.757,Z=-8.262,Z=-7.583,Z=-6.833,Z=-5.487,Z=-3.350,Z=-2.608,Z=-2.475;all P values＜0.05),and were lower in both groups after treatment than those before treatment(t=30.231-56.887,Z=-6.805 to-4.905;all P values＜0.05).The mean arterial pressure and oxygenation index were higher after treatment in observation group[(84.25±2.25),(265.19±12.85)mmHg]than those in control group[(76.57±2.77),(192.84±13.98)mmHg](t--14.604,P＜0.001;t=-25.844,P＜0.001),and were higher in both groups after treatment than those before treatment(t=-122.463 to-44.527;all P values＜0.05).All the above indexes showed no significant differences between two groups before treatment(t=-1.748-0.387,Z=-1.914 to-0.293;all P values＞0.05).Both before and after treatment,the HBP levels were positively correlated with SOFA scores in observation group(rs=0.714,P＜0.001;rs=0.679,P＜0.001)and in control group(rs=0.626,P＜0.001;r,=0.697,P＜0.001);and the reduction rates of HBP levels were positively correlated with the reduction rates of SOFA scores in observation and control groups(rs=0.446,P=0.002;r,=0.361,P=0.014).Conclusions Hemoperfusion(HA380)combined with CVVH can partially remove HBP and inflammatory mediators from the blood of septic patients,reduce inflammatory response,increase tissue perfusion and improve organ function.The HBP level can be used to assess the severity of sepsis and its change may reflect the effect of hemoperfusion(HA380)combined with CVVH treatment.
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