Kushi Hidehiko, Miki Takahiro, Nakahara Jun, Okamoto Kazuhiko, Kawahara Yayoi, Saito Takeshi, Tanjoh Katsuhisa
Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan.
Ther Apher Dial. 2006 Oct;10(5):425-9. doi: 10.1111/j.1744-9987.2006.00406.x.
In the present study, we examined whether the performance of hemoperfusion with an immobilized polymyxin B fiber column (DHP-PMX) reduces circulating interleukin-8 concentration in patients with sepsis. Fifteen patients with sepsis satisfying the following criteria were enrolled in the study: (i) signs of systemic inflammatory response syndrome caused by infection; and (ii) mean arterial blood pressure > or =60 mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP-PMX for appropriate intravenous infusion, and the DHP-PMX was carried out twice at 24 h intervals (for 3 h each time). Circulating interleukin-8 concentration was measured seven times. The sequential organ failure assessment (SOFA) score was calculated twice. Circulating interleukin-8 concentration was 55 +/- 15.7 pg/mL before DHP-PMX, while it was 101 +/- 58.8 pg/mL immediately after the first session of treatment. It was 24 +/- 9.0 pg/mL before the second session of DHP-PMX, and it was 28 +/- 8.0 pg/mL immediately after the second session. The IL-8 level was 17 +/- 4.3 pg/mL at 48 h afterward, and 18 +/- 4.3 pg/mL at 72 h afterward, showing a significant decrease from 48 h onwards, compared with before treatment (P < 0.05). The SOFA score was 9 +/- 1.5 and the APACHE II score was 19 +/- 2.0 before DHP-PMX, while the SOFA score was 7.0 +/- 0.9 at 72 h afterward, showing a significant decrease compared with before treatment (P < 0.05). The present findings indicate that DHP-PMX indirectly reduces circulating interleukin-8 concentration and improves SOFA score.
在本研究中,我们检测了使用固定化多黏菌素B纤维柱进行血液灌流(DHP-PMX)是否能降低脓毒症患者循环中的白细胞介素-8浓度。15例符合以下标准的脓毒症患者被纳入本研究:(i)由感染引起的全身炎症反应综合征的体征;(ii)平均动脉血压≥60 mmHg(无论是否使用儿茶酚胺)。在进行DHP-PMX之前插入热稀释导管以进行适当的静脉输注,DHP-PMX每隔24小时进行两次(每次3小时)。循环白细胞介素-8浓度测量了7次。序贯器官衰竭评估(SOFA)评分计算了两次。DHP-PMX前循环白细胞介素-8浓度为55±15.7 pg/mL,而在第一次治疗后立即为101±58.8 pg/mL。在第二次DHP-PMX前为24±9.0 pg/mL,在第二次治疗后立即为28±8.0 pg/mL。此后48小时白细胞介素-8水平为17±4.3 pg/mL,72小时时为18±4.3 pg/mL,与治疗前相比,从48小时起显著下降(P<0.05)。DHP-PMX前SOFA评分为9±1.5,急性生理与慢性健康状况评分系统(APACHE II)评分为19±2.0,而此后72小时SOFA评分为7.0±0.9,与治疗前相比显著下降(P<0.05)。目前的研究结果表明,DHP-PMX可间接降低循环白细胞介素-8浓度并改善SOFA评分。