Matsuda Kenichi, Moriguchi Takeshi, Oda Shigeto, Hirasawa Hiroyuki
Contrib Nephrol. 2010;166:83-92. doi: 10.1159/000314856. Epub 2010 May 7.
BACKGROUND/AIMS: In the pathophysiology of acute respiratory distress syndrome (ARDS), the increase in capillary and alveolar permeability caused by various humoral mediators and resultant pulmonary interstitial edema play major roles. In this study, the efficacy of continuous hemodiafiltration using a cytokine-adsorbing hemofilter with a membrane made of polymethylmethacrylate (PMMA-CHDF) in the treatment of ARDS patients was investigated.
Fifty-one patients with a diagnosis of ARDS complicated by renal failure and without prior steroid therapy were enrolled in this study. Changes in respiratory index (RI), positive end-expiratory pressure, central venous pressure (CVP) and blood levels of TNFalpha, IL-6 and IL-8 before/after blood purification for 3 days as well as the cumulative water balance during the 3-day treatment and 28-day cumulative survival rate were compared between 2 patient groups. One group underwent PMMA-CHDF and the other intermittent hemodialysis (IHD) without water removal for elimination of metabolites and continuous hemofiltration (CHF) for fluid management.
Blood purification for 3 days significantly decreased blood levels of cytokines and successfully removed water without changing CVP in the PMMA-CHDF group, but not in the IHD+CHF group. Significant correlations between changes in blood levels of cytokines (IL-6 and IL-8) and changes in RI were demonstrated in the PMMA-CHDF group. The 28-day cumulative survival rate in the PMMA-CHDF group (68.8%) was significantly higher than that in the IHD+CHF group (36.8%).
Cytokine removal therapy with PMMA-CHDF is expected to be useful as a new therapeutic modality in ARDS patients for non-renal indications.
背景/目的：在急性呼吸窘迫综合征（ARDS）的病理生理学中，各种体液介质引起的毛细血管和肺泡通透性增加以及由此导致的肺间质水肿起主要作用。本研究探讨了使用由聚甲基丙烯酸甲酯制成的膜的细胞因子吸附血液滤过器进行持续血液透析滤过（PMMA-CHDF）治疗ARDS患者的疗效。
本研究纳入了51例诊断为ARDS并伴有肾衰竭且未接受过类固醇治疗的患者。比较了两组患者在血液净化3天前后呼吸指数（RI）、呼气末正压、中心静脉压（CVP）以及TNFα、IL-6和IL-8血水平的变化，以及3天治疗期间的累计水平衡和28天累计生存率。一组接受PMMA-CHDF治疗，另一组接受间歇性血液透析（IHD）（不进行脱水以清除代谢产物）和持续血液滤过（CHF）（用于液体管理）。
血液净化3天后，PMMA-CHDF组细胞因子血水平显著降低，成功清除水分且CVP未改变，而IHD+CHF组则不然。PMMA-CHDF组细胞因子（IL-6和IL-8）血水平变化与RI变化之间存在显著相关性。PMMA-CHDF组的28天累计生存率（68.8%）显著高于IHD+CHF组（36.8%）。
PMMA-CHDF细胞因子清除疗法有望作为一种新的治疗方式用于ARDS患者的非肾脏适应证。
