组合式血液净化治疗对脓毒症患者血清炎症因子水平和临床预后的影响

doi:10.3877/cma.j.issn.1674-6880.2023.04.002

目的

探讨组合式血液净化治疗对脓毒症患者炎症因子水平和临床预后的影响。

方法

选取2020年12月至2021年8月新疆医科大学第一附属医院收治的28例脓毒症并进行血液净化治疗的患者为研究对象，采用随机分层化法将所有患者分为oXiris组（10例）、HA380组（7例）和oXiris + HA380组（11例）。oXiris组采用oXiris滤器行连续性静脉-静脉血液透析滤过（CVVHDF）血液净化治疗模式；HA380组采用ST100滤器联合HA380血液灌流器行CVVHDF血液吸附治疗模式；oXiris + HA380组采用oXiris滤器联合HA380血液灌流器行CVVHDF血液吸附治疗模式。于连续性肾脏替代疗法（CRRT）治疗0、2、4、6、12、24、48 h后，记录所有患者的血清炎症因子指标白细胞介素6（IL-6）、降钙素原（PCT）、高迁移率族蛋白B1（HMGB1）和干扰素γ（IFN-γ）。于治疗0、24、48 h后，记录患者序贯器官衰竭估计（SOFA）评分和急性病生理学和长期健康评价Ⅱ（APACHEⅡ）评分。同时，随访28 d，比较3组患者的生存情况。

结果

3组患者各时间点PCT（F = 18.507，P<0.001）、HMGB1（F = 3.831，P = 0.035）、IFN-γ（F = 5.549，P = 0.010）水平比较，差异均有统计学意义，而3组患者各时间点IL-6、SOFA评分及APACHEⅡ评分比较，差异均无统计学意义（F = 0.628、0.489、0.960，P = 0.542、0.621、0.397）。进一步两两比较发现，oXiris + HA380组患者的PCT水平治疗48 h后较治疗开始时显著下降，但与同期HA380组比较仍较高（P均<0.05）；oXiris + HA380组的HMGB1、IFN-γ水平在治疗48 h后均显著低于HA380组（P均<0.05），但与oXiris组比较差异均无统计学意义（P均>0.05）。随访28 d后，oXiris组患者存活6例，HA380组患者存活4例，oXiris + HA380组患者存活5例，3组患者生存情况比较差异无统计学意义（χ² = 0.493，P = 0.781）。

结论

oXiris联合HA380的组合式血液净化在一定程度上可以清除脓毒症患者血清中的炎症因子，但对预后影响不显著。

关键词: 脓毒症, 血液净化, 连续性肾脏替代治疗, 炎症因子, 预后

Objective

To explore the effect of combined blood purification on the levels of inflammatory cytokines and clinical prognosis in patients with sepsis.

Methods

From December 2020 to August 2021, 28 patients with sepsis undergoing blood purification in the First Affiliated Hospital of Xinjiang Medical University were randomly divided into three groups: oXiris group (10 cases), HA380 group (7 cases) and oXiris + HA380 group (11 cases) by random stratification. The oXiris group was treated with continuous veno-venous hemodiafiltration (CVVHDF) with the oXiris filter, the HA380 group was treated with CVVHDF blood adsorption by the ST100 filter combined with HA380 hemoperfusion, and the oXiris + HA380 group was treated with CVVHDF blood adsorption by the oXiris filter combined with HA380 hemoperfusion. The inflammatory cytokine indexes of interleukin-6 (IL-6), procalcitonin (PCT), high mobility group protein 1 (HMGB1) and interferon-gamma (IFN-γ) were recorded at 0, 2, 4, 6, 12, 24 and 48 h after continuous renal replacement therapy (CRRT) treatment respectively. The sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were recorded at 0, 24 and 48 h after CRRT treatment. At the same time, the survival status was followed up for 28 days.

Results

The levels of PCT (F = 18.507, P < 0.001), HMGB1 (F = 3.831, P = 0.035) and IFN-γ (F = 5.549, P = 0.010) among the three groups at each time point showed significant differences. However, there were no significant differences in IL-6, SOFA and APACHEⅡ scores among the three groups at each time point (F = 0.628, 0.489, 0.960; P = 0.542, 0.621, 0.397). Further pairwise comparison found that the PCT level in the oXiris + HA380 group decreased significantly after 48 h of treatment compared with the beginning of treatment, but it was still higher than that in the HA380 group at the same time (both P < 0.05). The levels of HMGB1 and IFN-γ in the oXiris + HA380 group were much lower than those in the HA380 group after 48 h of treatment (both P < 0.05), but the difference was not statistically significant compared with the oXiris group at the same time (both P > 0.05). After 28 days of follow-up, six patients survived in the oXiris group, four patients survived in the HA380 group, and five patients survived in the oXiris + HA380 group. There was no statistically significant difference in survival among the three groups (χ² = 0.493, P = 0.781).

Conclusion

oXiris combined with HA380 hemoperfusion can remove inflammatory cytokines in the serum of patients with sepsis to a certain extent, but it has no significant effect onprognosis.

Key words: Sepsis, Blood purification, Continuous renal replacement therapy, Inflammatory cytokines, Prognosis

表1 3组脓毒症患者基本临床资料的比较

组别	例数	年龄（岁， ± s）	男/女（例）	感染情况（例）				合并疾病（例）
组别	例数	年龄（岁， ± s）	男/女（例）	肺部感染	腹腔感染	泌尿系统感染	软组织感染	高血压	糖尿病	慢性肾脏疾病	肝功能不全
oXiris组	10	58 ± 11	8/2	7	4	2	2	2	3	3	2
HA380组	7	60 ± 29	4/3	6	4	1	1	4	2	5	1
oXiris + HA380组	11	61 ± 20	9/2	8	9	5	3	2	6	4	6
F/χ²值		0.110	1.597	0.592	3.980	2.596	0.447	3.742	1.722	3.198	4.231
P值		0.909	0.450	0.744	0.143	0.273	0.800	0.154	0.412	0.202	0.121
组别	例数	并发症（例）						病原体类型（例）			28 d生存
组别	例数	呼吸衰竭	心力衰竭	急性肝损伤	急性肾损伤	电解质紊乱	脓毒性休克	革兰阴性菌	革兰阳性菌	真菌	28 d生存
oXiris组	10	8	6	7	10	2	6	7	2	5	6
HA380组	7	2	2	4	4	2	2	2	1	2	4
oXiris + HA380组	11	5	4	8	9	4	6	6	1	3	5
F/χ²值		4.859	1.973	0.590	5.157	0.687	1.777	2.848	0.509	1.386	0.493
P值		0.088	0.373	0.775	0.076	0.709	0.411	0.241	0.775	0.500	0.781

表1 3组脓毒症患者基本临床资料的比较

组别	例数	年龄（岁， ± s）	男/女（例）	感染情况（例）				合并疾病（例）
组别	例数	年龄（岁， ± s）	男/女（例）	肺部感染	腹腔感染	泌尿系统感染	软组织感染	高血压	糖尿病	慢性肾脏疾病	肝功能不全
oXiris组	10	58 ± 11	8/2	7	4	2	2	2	3	3	2
HA380组	7	60 ± 29	4/3	6	4	1	1	4	2	5	1
oXiris + HA380组	11	61 ± 20	9/2	8	9	5	3	2	6	4	6
F/χ²值		0.110	1.597	0.592	3.980	2.596	0.447	3.742	1.722	3.198	4.231
P值		0.909	0.450	0.744	0.143	0.273	0.800	0.154	0.412	0.202	0.121
组别	例数	并发症（例）						病原体类型（例）			28 d生存
组别	例数	呼吸衰竭	心力衰竭	急性肝损伤	急性肾损伤	电解质紊乱	脓毒性休克	革兰阴性菌	革兰阳性菌	真菌	28 d生存
oXiris组	10	8	6	7	10	2	6	7	2	5	6
HA380组	7	2	2	4	4	2	2	2	1	2	4
oXiris + HA380组	11	5	4	8	9	4	6	6	1	3	5
F/χ²值		4.859	1.973	0.590	5.157	0.687	1.777	2.848	0.509	1.386	0.493
P值		0.088	0.373	0.775	0.076	0.709	0.411	0.241	0.775	0.500	0.781

表2 3组脓毒症患者血清炎症因子水平、SOFA评分及APACHEⅡ评分比较（ ± s）

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
oXiris组
0 h	10	477 ± 268	36.0 ± 22.3	1 044 ± 1 014	20.5 ± 3.2	14 ± 5	23 ± 7
2 h	10	396 ± 221	25.2 ± 18.0	535 ± 318	25.6 ± 12.2	-	-
4 h	10	410 ± 313	29.6 ± 15.5	902 ± 503	23.0 ± 12.2	-	-
6 h	10	414 ± 288	37.2 ± 17.4	1 201 ± 489^e	12.5 ± 1.8^deh	-	-
12 h	10	338 ± 179	44.5 ± 27.5	1 104 ± 879^e	13.8 ± 2.8^deh	-	-
24 h	10	334 ± 190	31.9 ± 11.2	1 301 ± 897^e	15.0 ± 3.0	14 ± 4	19 ± 6
48 h	10	311 ± 214	23.1 ± 9.2^a	591 ± 180^afg	14.0 ± 2.0^deh	12 ± 5	17 ± 5
HA380组
0 h	7	412 ± 229	5.7 ± 2.8^b	902 ± 427	52.5 ± 39.5^b	12 ± 4	26 ± 6
2 h	7	383 ± 290	5.2 ± 1.9^b	702 ± 432	26.3 ± 19.0^d	-	-
4 h	7	523 ± 345	5.8 ± 1.2^b	930 ± 523	25.0 ± 17.0^d	-	-
6 h	7	454 ± 340	6.0 ± 2.5^b	770 ± 325	26.0 ± 11.5^bd	-	-
12 h	7	460 ± 236	7.9 ± 3.0^b	641 ± 240	20.4 ± 5.8^bd	-	-
24 h	7	489 ± 218	8.6 ± 7.7^b	738 ± 277	22.0 ± 6.8^bd	11 ± 4	23 ± 6
48 h	7	485 ± 286	7.7 ± 7.6^b	748 ± 209	20.8 ± 7.6^bd	10 ± 4	21 ± 5
oXiris + HA380组
0 h	11	655 ± 241	41.4 ± 17.4^c	675 ± 281	27.7 ± 23.5^c	13 ± 5	22 ± 6
2 h	11	482 ± 337	38.0 ± 21.0^c	581 ± 375	17.1 ± 10.0^d	-	-
4 h	11	346 ± 281	30.3 ± 25.2^c	524 ± 309	15.2 ± 8.0^d	-	-
6 h	11	412 ± 199	34.6 ± 24.2^c	575 ± 421^b	13.8 ± 3.8^cd	-	-
12 h	11	277 ± 139	23.9 ± 14.0^c	614 ± 150^b	10.7 ± 4.1^cd	-	-
24 h	11	290 ± 181	27.3 ± 18.4^c	516 ± 266^b	11.7 ± 5.8^cd	12 ± 4	19 ± 7
48 h	11	324 ± 238	19.5 ± 11.1^cd	445 ± 134^c	12.2 ± 5.4^cd	11 ± 4	18 ± 6
F值		0.628	18.507	3.831	5.549	0.489	0.960
P值		0.542	<0.001	0.035	0.010	0.621	0.397

表2 3组脓毒症患者血清炎症因子水平、SOFA评分及APACHEⅡ评分比较（ ± s）

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
oXiris组
0 h	10	477 ± 268	36.0 ± 22.3	1 044 ± 1 014	20.5 ± 3.2	14 ± 5	23 ± 7
2 h	10	396 ± 221	25.2 ± 18.0	535 ± 318	25.6 ± 12.2	-	-
4 h	10	410 ± 313	29.6 ± 15.5	902 ± 503	23.0 ± 12.2	-	-
6 h	10	414 ± 288	37.2 ± 17.4	1 201 ± 489^e	12.5 ± 1.8^deh	-	-
12 h	10	338 ± 179	44.5 ± 27.5	1 104 ± 879^e	13.8 ± 2.8^deh	-	-
24 h	10	334 ± 190	31.9 ± 11.2	1 301 ± 897^e	15.0 ± 3.0	14 ± 4	19 ± 6
48 h	10	311 ± 214	23.1 ± 9.2^a	591 ± 180^afg	14.0 ± 2.0^deh	12 ± 5	17 ± 5
HA380组
0 h	7	412 ± 229	5.7 ± 2.8^b	902 ± 427	52.5 ± 39.5^b	12 ± 4	26 ± 6
2 h	7	383 ± 290	5.2 ± 1.9^b	702 ± 432	26.3 ± 19.0^d	-	-
4 h	7	523 ± 345	5.8 ± 1.2^b	930 ± 523	25.0 ± 17.0^d	-	-
6 h	7	454 ± 340	6.0 ± 2.5^b	770 ± 325	26.0 ± 11.5^bd	-	-
12 h	7	460 ± 236	7.9 ± 3.0^b	641 ± 240	20.4 ± 5.8^bd	-	-
24 h	7	489 ± 218	8.6 ± 7.7^b	738 ± 277	22.0 ± 6.8^bd	11 ± 4	23 ± 6
48 h	7	485 ± 286	7.7 ± 7.6^b	748 ± 209	20.8 ± 7.6^bd	10 ± 4	21 ± 5
oXiris + HA380组
0 h	11	655 ± 241	41.4 ± 17.4^c	675 ± 281	27.7 ± 23.5^c	13 ± 5	22 ± 6
2 h	11	482 ± 337	38.0 ± 21.0^c	581 ± 375	17.1 ± 10.0^d	-	-
4 h	11	346 ± 281	30.3 ± 25.2^c	524 ± 309	15.2 ± 8.0^d	-	-
6 h	11	412 ± 199	34.6 ± 24.2^c	575 ± 421^b	13.8 ± 3.8^cd	-	-
12 h	11	277 ± 139	23.9 ± 14.0^c	614 ± 150^b	10.7 ± 4.1^cd	-	-
24 h	11	290 ± 181	27.3 ± 18.4^c	516 ± 266^b	11.7 ± 5.8^cd	12 ± 4	19 ± 7
48 h	11	324 ± 238	19.5 ± 11.1^cd	445 ± 134^c	12.2 ± 5.4^cd	11 ± 4	18 ± 6
F值		0.628	18.507	3.831	5.549	0.489	0.960
P值		0.542	<0.001	0.035	0.010	0.621	0.397

表3 生存组与死亡组脓毒症患者血清炎症因子水平、SOFA评分及APACHEⅡ评分比较（ ± s）

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
生存组
0 h	15	549 ± 319	36 ± 24	749 ± 304	31 ± 8	12 ± 4	22 ± 7
2 h	15	432 ± 301	28 ± 23	594 ± 322	22 ± 14	-	-
4 h	15	382 ± 309	26 ± 24	810 ± 509	20 ± 13	-	-
6 h	15	417 ± 287	30 ± 22	950 ± 499	18 ± 10	-	-
12 h	15	356 ± 225	31 ± 27	771 ± 411	13 ± 6	-	-
24 h	15	319 ± 164	28 ± 17	801 ± 503	15 ± 4	11 ± 4	18 ± 6^a
48 h	15	358 ± 260	21 ± 13	599 ± 187	16 ± 7	10 ± 4	16 ± 5^a
死亡组
0 h	13	492 ± 291	23 ± 19	957 ± 903	33 ± 20	14 ± 5	26 ± 6
2 h	13	465 ± 260	21 ± 18	591 ± 396	23 ± 13	-	-
4 h	13	446 ± 304	21 ± 17	666 ± 394	21 ± 12	-	-
6 h	13	424 ± 242	24 ± 22	731 ± 460	16 ± 5	-	-
12 h	13	340 ± 168	24 ± 19	887 ± 787	16 ± 5	-	-
24 h	13	396 ± 234	19 ± 14	944 ± 783	17 ± 8	14 ± 4	23 ± 6^b
48 h	13	357 ± 216	14 ± 8	512 ± 260	14 ± 5	12 ± 3	20 ± 5^ab
F值		0.045	1.805	0.002	0.012	2.165	5.371
P值		0.834	0.191	0.962	0.915	0.153	0.028

表3 生存组与死亡组脓毒症患者血清炎症因子水平、SOFA评分及APACHEⅡ评分比较（ ± s）

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
生存组
0 h	15	549 ± 319	36 ± 24	749 ± 304	31 ± 8	12 ± 4	22 ± 7
2 h	15	432 ± 301	28 ± 23	594 ± 322	22 ± 14	-	-
4 h	15	382 ± 309	26 ± 24	810 ± 509	20 ± 13	-	-
6 h	15	417 ± 287	30 ± 22	950 ± 499	18 ± 10	-	-
12 h	15	356 ± 225	31 ± 27	771 ± 411	13 ± 6	-	-
24 h	15	319 ± 164	28 ± 17	801 ± 503	15 ± 4	11 ± 4	18 ± 6^a
48 h	15	358 ± 260	21 ± 13	599 ± 187	16 ± 7	10 ± 4	16 ± 5^a
死亡组
0 h	13	492 ± 291	23 ± 19	957 ± 903	33 ± 20	14 ± 5	26 ± 6
2 h	13	465 ± 260	21 ± 18	591 ± 396	23 ± 13	-	-
4 h	13	446 ± 304	21 ± 17	666 ± 394	21 ± 12	-	-
6 h	13	424 ± 242	24 ± 22	731 ± 460	16 ± 5	-	-
12 h	13	340 ± 168	24 ± 19	887 ± 787	16 ± 5	-	-
24 h	13	396 ± 234	19 ± 14	944 ± 783	17 ± 8	14 ± 4	23 ± 6^b
48 h	13	357 ± 216	14 ± 8	512 ± 260	14 ± 5	12 ± 3	20 ± 5^ab
F值		0.045	1.805	0.002	0.012	2.165	5.371
P值		0.834	0.191	0.962	0.915	0.153	0.028

1	Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47 (11): 1181-1247.
2	Putzu A, Schorer R, Lopez-Delgado JC, et al. Blood purification and mortality in sepsis and septic shock: a systematic review and meta-analysis of randomized trials[J]. Anesthesiology, 2019, 131 (3): 580-593.
3	Prescott HC, Angus DC. Enhancing recovery from sepsis: a review[J]. JAMA, 2018, 319 (1): 62-75.
4	Angus DC, van der Poll T. Severe sepsis and septic shock[J]. N Engl J Med, 2013, 369 (9): 840-851.
5	Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis[J]. Crit Care, 2011, 15 (1): 205.
6	Hellman T, Uusalo P, Jarvisalo MJ. Renal replacement techniques in septic shock[J]. Int J Mol Sci, 2021, 22 (19): 10238.
7	Ankawi G, Neri M, Zhang J, et al. Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls[J]. Crit Care, 2018, 22 (1): 262.
8	董伟，陈校园，曹晓东，等.血液净化治疗在脓毒血症中的研究与应用进展[J].中国血液净化，2017,16（8）：562-565.
9	Monard C, Rimmelé T, Ronco C. Extracorporeal blood purification therapies for sepsis[J]. Blood Purif, 2019 (47 Suppl 3): 1-14.
10	Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices[J]. Intensive Care Med Exp, 2018, 6 (1): 12.
11	Pomarè Montin D, Ankawi G, Lorenzin A, et al. Biocompatibility and cytotoxic evaluation of new sorbent cartridges for blood hemoperfusion[J]. Blood Purif, 2018, 46 (3): 187-195.
12	Sun S, He L, Bai M, et al. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study[J]. Ann Saudi Med, 2015, 35 (5): 352-358.
13	Wang YT, Fu JJ, Li XL, et al. Effects of hemodialysis and hemoperfusion on inflammatory factors and nuclear transcription factors in peripheral blood cell of multiple organ dysfunction syndrome[J]. Eur Rev Med Pharmacol Sci, 2016, 20 (4): 745-750.
14	Dastan F, Saffaei A, Mortazavi SM, et al. Continues renal replacement therapy (CRRT) with disposable hemoperfusion cartridge: a promising option for severe COVID-19[J]. J Glob Antimicrob Resist, 2020 (21): 340-341.
15	He Z, Lu H, Jian X, et al. The efficacy of resin hemoperfusion cartridge on inflammatory responses during adult cardiopulmonary bypass[J]. Blood Purif, 2022, 51 (1): 31-37.
16	Standage SW, Wong HR. Biomarkers for pediatric sepsis and septic shock[J]. Expert Rev Anti Infect Ther, 2011, 9 (1): 71-79.
17	Covington EW, Roberts MZ, Dong J. Procalcitonin monitoring as a guide for antimicrobial therapy: a review of current literature[J]. Pharmacotherapy, 2018, 38 (5): 569-581.
18	Turani F, Barchetta R, Falco M, et al. Continuous renal replacement therapy with the adsorbing filter oXiris in septic patients: a case series[J]. Blood Purif, 2019 (47 Suppl 3): 1-5.
19	Yaroustovsky M, Abramyan M, Krotenko N, et al. A pilot study of selective lipopolysaccharide adsorption and coupled plasma filtration and adsorption in adult patients with severe sepsis[J]. Blood Purif, 2015, 39 (1-3): 210-217.
20	Zhai Y, Pan J, Zhang C. The application value of oXiris-endotoxin adsorption in sepsis[J]. Am J Transl Res, 2021, 13 (4): 3839-3844.
21	Dou YH, Du JK, Liu HL, et al. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis[J]. Diagn Microbiol Infect Dis, 2013, 76 (4): 464-469.
22	Maisel A, Neath SX, Landsberg J, et al. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial[J]. Eur J Heart Fail, 2012, 14 (3): 278-286.
23	吕铁，应利君，席小龙.连续性肾脏替代疗法叠加全血吸附改善脓毒性休克患者心肌抑制的疗效研究[J/CD].中华危重症医学杂志（电子版），2020，13（5）：334-338.
24	孙雪东，严一核，褚韦韦，等.高迁移率族蛋白B1/Toll样受体4信号通路在脓毒症大鼠致急性肺损伤中的作用研究[J/CD].中华危重症医学杂志（电子版），2020，13（6）：419-426.
25	Angus DC, Yang L, Kong L, et al. Circulating high-mobility group box 1 (HMGB1) concentrations are elevated in both uncomplicated pneumonia and pneumonia with severe sepsis[J]. Crit Care Med, 2007, 35 (4): 1061-1067.
26	Cai J, Lin Z. Correlation of blood high mobility group box-1 protein with mortality of patients with sepsis: a meta-analysis[J]. Heart Lung, 2021, 50 (6): 885-892.
27	Li J, Kokkola R, Tabibzadeh S, et al. Structural basis for the proinflammatory cytokine activity of high mobility group box 1[J]. Mol Med, 2003, 9 (1-2): 37-45.
28	Kim EY, Ner-Gaon H, Varon J, et al. Post-sepsis immunosuppression depends on NKT cell regulation of mTOR/IFN-γ in NK cells[J]. J Clin Invest, 2020, 130 (6): 3238-3252.
29	Deitch EA. Tumor necrosis factor as the proximal mediator of sepsis-or this too will pass[J]. Crit Care Med, 1995, 23 (9): 1457-1458.
30	Matsumura T, Ito A, Takii T, et al. Endotoxin and cytokine regulation of toll-like receptor (TLR) 2 and TLR4 gene expression in murine liver and hepatocytes[J]. J Interferon Cytokine Res, 2000, 20 (10): 915-921.
31	Wolfs TG, Buurman WA, van Schadewijk A, et al. In vivo expression of Toll-like receptor 2 and 4 by renal epithelial cells: IFN-gamma and TNF-alpha mediated up-regulation during inflammation[J]. J Immunol, 2002, 168 (3): 1286-1293.
32	Broman ME, Hansson F, Vincent JL, et al. Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: a randomized crossover double-blind study[J]. PLoS One, 2019, 14 (8): e220444.

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Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis

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Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis