Direct Hemoperfusion Using Immobilized Polymyxin B in Patients with Rapidly Progressive Interstitial Pneumonias: A Retrospective Study
Direct Hemoperfusion Using Immobilized Polymyxin B in Patients with Rapidly Progressive Interstitial Pneumonias: A Retrospective Study
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DOI：
10.1159/000321958
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发表时间：
2011-01-01
期刊：
影响因子：
3.7
通讯作者：
Kohno, Shigeru
中科院分区：
文献类型：
--
作者：
Hara, Shintaro;Ishimoto, Hiroshi;Kohno, Shigeru
背景：快速进展的间质性肺炎（IP），包括IP的急性加重，具有很高的死亡率。多粘菌素B固定纤维柱直接血液灌流（PMX-DHP）最近被确定为脓毒症相关急性呼吸窘迫综合征的有效治疗方法。然而，关于PMX-DHP治疗快速进展性IP的有效性知之甚少。目的：本研究探讨PMX-DHP对快速进展的IP是否安全有效。研究方法：我们回顾性研究了PMX-DHP在33例对类固醇冲击治疗耐药的快速进展性IP患者中的作用。2006年至2009年间，患者在长崎大学医院住院。结果如下：PMX-DHP后72小时，动脉血氧分压/吸入氧分数比（中位数127-153 mm Hg）显著改善。PMX-DHP后1周，尽管皮质类固醇脉冲治疗无效，但动脉氧分压/吸入氧分数比（中位数127-227 mm Hg）、肺泡-动脉氧差（中位数371-177 mm Hg）和全身炎症反应综合征阳性标准的数量均显著改善。PMX-DHP治疗后即刻，血清单核细胞趋化蛋白1水平显著降低。结论：PMX-DHP可安全有效地改善快速进展性IP患者的氧合和全身炎症反应综合征。PMX-DHP的有益作用可能至少部分是由于单核细胞活化的抑制。版权所有（C）2010 S. Karger AG，巴塞尔
Background: Rapidly progressive interstitial pneumonia (IP), including acute exacerbation of IP, has a high mortality rate. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) was recently identified as an effective treatment for sepsis-associated acute respiratory distress syndrome. However, little is known about the effectiveness of PMX-DHP for rapidly progressive IP. Objectives: The present study investigates whether PMX-DHP is safe and effective against rapidly progressive IP. Methods: We retrospectively examined the effects of PMX-DHP in 33 consecutive patients with rapidly progressive IP who were resistant to steroid pulse therapy. Patients were hospitalized at Nagasaki University Hospital between 2006 and 2009. Results: Seventy-two hours after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127-153 mm Hg) had significantly improved. One week after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127-227 mm Hg), the alveolar-arterial difference of oxygen (median 371-177 mm Hg) and the number of positive criteria for systemic inflammatory response syndrome had significantly improved, despite the ineffectiveness of corticosteroid pulse therapy. The serum level of monocyte chemotactic protein 1 was significantly decreased immediately after PMX-DHP. Conclusions: PMX-DHP was safe and effective in improving oxygenation and systemic inflammatory response syndrome in patients with rapidly progressive IP. The beneficial effects of PMX-DHP may be at least partially due to the inhibition of monocyte activation. Copyright (C) 2010 S. Karger AG, Basel