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Einfluss von Ultrafiltrationsmethoden und Filtertypen auf die Elimination inflammatorischer Zytokine in der Kinderherzchirurgie

Effects of ultrafiltration method and filter type on inflammatory cytokines in pediatric cardiac surgery

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Zeitschrift für Herz-, Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Ziel

Zu untersuchen, ob verschiedene Ultrafiltrationsmethoden oder Filtertypen den Zytokinverlauf bei Kinderherzoperationen unterschiedlich beeinflussen.

Methode

41 Kinder <5-jährig wurden prospektiv in die Gruppe A: Polyamidfilter (PAF) mit konventioneller Ultrafiltration (KUF); B: PAF mit modifizierter Ultrafiltration (MUF); C: Polysulfonfilter (PSF) mit KUF oder D: PSF mit MUF randomisiert. IL-6, IL-10, TNF, terminaler Komplement-Komplex (TCC) und Laktoferrin (LF) wurden vor der Operation (T0), vor dem Aufwärmen (T1), nach der Ultrafiltration (T2), 6 (T3) und 18 Stunden postoperativ (T4) im Plasma und Ultrafiltrat bestimmt.

Resultate

Die Plasmakonzentrationen aller Marker veränderten sich mit beiden Filtrationsmethoden, mit beiden Filtertypen und in allen Gruppen (Ausnahme TNF) während der Beobachtungszeit von T0 bis T4 (p<0,0001). Deren Verlaufsmuster waren verschieden bei TCC mit einer kleineren Abnahme nach PSF (p<0,05) und bei IL-6 in A–D (p=0,01) mit einer größeren Abnahme in C als in A (p<0,02). IL-10 wurde mit PAF (p<0,001) nicht jedoch mit PSF vermindert. Im Ultrafiltrat war die TNF-Konzentration mit PSF höher als mit PAF (6.8±5 vs. 4.0±3.7 pg/ml; p<0,05). Das Ultrafiltrat/Plasma-Verhältnis von IL-6 war mit KUF größer als mit MUF (0,018±0,017 vs. 0,004±0,007; p<0,005).

Schlussfolgerungen

PSF zeigt für IL-6, TNF und IL-10 ein vorteilhafteres Filtrationsprofil als PAF. IL-6 wird am effizientesten durch KUF mit PSF filtriert und TNF durch MUF mit PSF, während andere Entzündungsmediatoren weder durch unterschiedliche Filtertypen noch durch verschiedene UF-Methoden beeinflusst werden. Somit scheint die Kombination von KUF und MUF mit PSF die zur Zeit effizienteste Methode zur Zytokinelimination in der Kinderherzchirurgie zu sein.

Summary

Objective

Assessment of the influence of different filter types and ultrafiltration (UF) methods on inflammatory markers in pediatric cardiac surgery.

Methods

41 children <5 y were prospectively randomized to group A: polyamid filter (PAF) with conventional UF (CUF); B: PAF with modified UF (MUF); C: polysulfon filter (PSF) with CUF; or D: PSF with MUF. IL-6, IL-10, TNF, terminal complement complex (TCC) and lactoferrin (LF) were measured before surgery (T0), before rewarming (T1), after UF (T2), at 6 h (T3) and 18 h (T4) post- operatively in the serum and in the ultrafiltrate.

Results

All markers changed with both UF methods, both filter types and in all groups (except TNF) along the T0-4 observation time (p<0.0001). Their changing patterns were different for TCC with less decrease after PSF (p<0.05), and among groups A–D for IL-6 (p=0.01) with more decrease in C than A (p<0.02). IL-10 decreased with PAF (p<0.001), but not with PSF. In the ultrafiltrate, TNF was higher with PSF than PAF (6.8±5 vs. 4.0±3.7 pg/ml; p<0.05). The ultrafiltrate/plasma ratio of IL-6 was higher with CUF than MUF (0.018±0.017 vs. 0.004±0.007; p<0.005).

Conclusions

PSF shows a superior filtration profile of inflammatory mediators compared to PAF concerning IL-6, TNF and IL-10. IL-6 is most efficiently removed by CUF with PSF and TNF by MUF with PSF, whereas other inflammatory mediators are not influenced by filter type or UF method. Therefore, combined CUF/MUF with PSF may currently be the most effective strategy to remove inflammatory mediators in pediatric open heart surgery.

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Authors and Affiliations

  1. Klinik für Herz- und Gefäßchirurgie, Universitätsspital, 3010, Bern, Switzerland

    P. A. Berdat

  2. Regionalspital Emmental, 3400, Burgdorf, Switzerland

    E. Eichenberger

  3. Spital Zweisimmen, 3770, Zweisimmen, Switzerland

    J. Ebell

  4. Klinik für Herz- und Gefäßchirurgie, Abt. für Kinderkardiologie, Universitätsspital, 3010, Bern, Switzerland

    J.-P. Pfammatter &  M. Pavlovic

  5. Klinik für Herz- und Gefäßchirurgie, Abt. für kardiovaskuläre Anästhesie, Universitätsspital, 3010, Bern, Switzerland

    C. Zobrist

  6. Universitätsspital, 3010, Bern, Switzerland

    E. Gygax (Leiter Abt. Kardiotechnik)

  7. Klinik für Herz- und Gefäßchirurgie, Universitätsspital, 3010, Bern, Switzerland

    U. Nydegger (Leiter Abt. Forschung und Entwicklung)

  8. Universitätsspital, 3010, Bern, Germany

    T. Carrel (Direktor der Klinik für Herz- und Gefäßchirurgie)

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  1. P. A. Berdat
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Correspondence to P. A. Berdat.

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Berdat, P.A., Eichenberger, E., Ebell, J. et al. Einfluss von Ultrafiltrationsmethoden und Filtertypen auf die Elimination inflammatorischer Zytokine in der Kinderherzchirurgie. Z Herz-, Thorax-, Gefäßchir 18, 237–245 (2004). https://doi.org/10.1007/s00398-004-0462-0

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  • DOI: https://doi.org/10.1007/s00398-004-0462-0

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