Effects of Direct Hemoperfusion with Polymyxin B-immobilized Fiber on Rapidly Progressive Interstitial Lung Diseases
Effects of Direct Hemoperfusion with Polymyxin B-immobilized Fiber on Rapidly Progressive Interstitial Lung Diseases
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DOI：
10.2169/internalmedicine.53.2687
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发表时间：
2014-01-01
影响因子：
1.2
通讯作者：
Narita, Ichiei
中科院分区：
文献类型：
--
作者：
Takada, Toshinori;Asakawa, Katsuaki;Narita, Ichiei
目的应用多粘菌素B固定化纤维柱直接血液灌流(PMX-DHP)治疗感染性休克。最近有研究表明，PMX-DHP对特发性肺纤维化(IPF)的急性加重也可能有效。然而，以前的所有报告都是没有控制的病例系列。本研究的目的是在病例对照研究中确定PMX-DHP对快速进展性间质性肺病(ILDS)患者预后的影响。方法我们回顾了我所连续收治的IPF急性加重或快速进展性ILDS患者的临床记录。我们排除了那些接受过肺部疾病类固醇脉冲治疗的患者，包括每天口服强的松龙超过15毫克的患者，或在急性呼吸衰竭发生前一个月内接受手术的患者。比较接受PMX-DP治疗和不接受PMX-DP治疗的患者的实验室检查结果和生存情况。其中13例患者在免疫抑制治疗的基础上加用PMX-DHP治疗，包括激素冲击治疗。接受PMX-DHP治疗的患者的平均生存时间往往长于未接受PXM-DHP治疗的患者(p=0.067)。激素冲击治疗第1天接受PMX-DHP治疗的6例患者的生存时间明显长于单用标准药物治疗的患者(P<；0.01)。结论激素冲击治疗第1天进行PMX-DHP治疗可能改善急进型ILDS患者的预后。
Objective Direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX-DHP) has been used for the treatment of septic shock. It was recently suggested that PMX-DHP may also be effective in acute exacerbations of idiopathic pulmonary fibrosis (IPF). However, all previous reports are case series without controls. The aim of the study was to determine the effects of PMX-DHP on the prognosis of the patients with rapidly progressive interstitial lung diseases (ILDs) in a case-control setting.Methods We herein retrospectively examined the clinical records of consecutive patients with acute exacerbation of IPF or rapidly progressive ILDs treated in our institute. We excluded those who had been treated with steroid pulse therapy for lung diseases, including those who had been taking more than 15 mg of oral prednisolone daily, or had undergone an operation within one month before the onset of acute respiratory failure. We compared the results of the laboratory tests and survivals between patients treated with and without PMX-DHP.Results Twenty-six patients were enrolled in the study. Among them, 13 patients were treated with PMX-DHP in addition to immunosuppressive therapy, including steroid pulse therapy. The mean survival time of patients treated with PMX-DHP tended to be longer than patients not treated with PXM-DHP (p = 0.067). Six patients who underwent PMX-DHP on the first day of steroid pulse therapy had significantly longer survival times than those who were treated with standard medication alone (p < 0.01).Conclusion These results suggest that PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive ILDs.