Effect of pulse high-volume hemofiltration on Toll-like receptor expression and organ function in patients with severe sepsis

Objective To investigate the clinical significance of pulse high-volume hemofiltration (PHVHF) on expressions of Toll-like receptor (TLR) 2 and TLR4 mRNA in peripheral blood mononuclear cells (PBMCs) in patients with severe sepsis.Methods Forty patients with severe sepsis were divided into conventional treatment group (n =20) and PHVHF group (n =20) according to random number table.Another fifteen healthy volunteers served as controls.TLR2 and TLR4 mRNA expressions in PBMCs were detected using RT-PCR and plasma concentrations of TNF-α and IL-6 were measured using ELISA method before therapy and at 24 h,48 h and 72 h after therapy.Vital signs,BIL,Cr,BUN,Lac,PaO2/FiO2,acute physiology,chronic health evaluation Ⅱ (APPACHE Ⅱ),sequential organ failure assessment (SOFA) and prognosis were compared among the groups.Besides,complications associated with PHVHF therapy were monitored.Results Expressions of TLR2 and TLR4 mRNA in PBMCs and concentrations of TNF-α and IL-6 were significantly higher in patients with severe sepsis than in the controls (P ＜ 0.01).At 72 hours after therapy,PHVHF group showed significantly lower concentrations of TNF-α and IL-6 than those before therapy (P ＜ 0.01) as well as significantly lower expressions of TLR2 and TLR4 mRNA in PBMCs than those in conventional treatment group (P ＜ 0.O1).However,no significant decline in the levels of TNF-α and IL-6 and the expressions of TLR2 and TLR4 mRNA in PBMCs were shown in conventional treatment group after therapy.At 72 hours after therapy,PHVHF group showed significant increases of MAP and PaO2/FiO2 and significant decreases of Cr,BUN,Lac,APACHE Ⅱ and SOFA as compared to those before therapy (P ＜ 0.05).Moreover,the differences of MAP,PaO2/FiO2,Cr,BUN,Lac,APACHE Ⅱ and SOFA were statistically significant between and conventional treatment group at 72 hours after therapy (P ＜ 0.05).Conclusion PHVHF achieves a reduced systemic inflammatory response,improved major organ functions,shortened length of stay in ICU and down-regulated TLR2 and TLR4 expressions in PBMCs that may be a novel mechanism of PHVHF in treatment of severe sepsis. Key words: Hemofiltration ;  Sepsis ;  Toll-like receptors