Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Japan.
Shock. 2011 Oct;36(4):332-8. doi: 10.1097/SHK.0b013e318225f839.
Endotoxin, an outer membrane component of gram-negative bacteria, plays an important role in the pathogenesis of septic shock. Endotoxin adsorption therapy by polymyxin B-immobilized fiber column hemoperfusion (PMX) has been used for the treatment of septic shock patients in Japan since 1994. The covalent binding of polymyxin B onto the surface of the polystyrene-based carrier fiber in PMX inactivates the endotoxin in the blood without exerting toxicity. This study was performed as a systematic review to evaluate the efficacy and mechanism of PMX treatment in patients with septic shock. The PubMed database and references from identified articles were used to search and review the literature relating to the efficacy and mechanism of PMX treatment in patients with septic shock. Polymyxin B-immobilized fiber column hemoperfusion adsorbed monocytes, activated neutrophils, and anandamide, as well as endotoxin through direct covalent bond, hydrophobic and ionic interactions, and hydrodynamics, and reduced the blood concentrations of inflammatory cytokines, plasminogen activator inhibitor 1 and adhesion molecules. Polymyxin B-immobilized fiber column hemoperfusion increased blood pressure and reduced the dosage requirements for vasopressive/inotropic agents. The meta-analysis showed that PMX treatment had beneficial effects on the hemodynamics, pulmonary oxygenation, and mortality. These beneficial effects may be attributable to the direct adsorption of endotoxin, monocytes, activated neutrophils, and anandamide, as well as indirect decrease in inflammatory cytokines and other mediators. Polymyxin B-immobilized fiber column hemoperfusion treatment has additional effects on reducing endothelial damage, proapoptotic activity, and immunosuppression. Further studies will be needed to confirm the efficacy and mechanism of PMX treatment in septic shock.
内毒素是革兰氏阴性菌外膜的组成部分，在感染性休克的发病机制中起重要作用。自 1994 年以来，聚马菌素 B 固定化纤维柱血液灌流（PMX）吸附疗法已在日本用于治疗感染性休克患者。PMX 中聚马菌素 B 与基于聚苯乙烯的载体纤维表面的共价结合使血液中的内毒素失活而不产生毒性。本研究进行了系统评价，以评估 PMX 治疗感染性休克患者的疗效和机制。使用 PubMed 数据库和已确定文章的参考文献搜索和综述与 PMX 治疗感染性休克患者的疗效和机制相关的文献。聚马菌素 B 固定化纤维柱血液灌流通过直接共价键、疏水性和离子相互作用以及流体动力学吸附单核细胞、活化的中性粒细胞和花生四烯酸，以及内毒素，并降低炎症细胞因子、纤溶酶原激活物抑制剂 1 和黏附分子的血液浓度。聚马菌素 B 固定化纤维柱血液灌流增加血压并降低血管加压/正性肌力药物的剂量需求。荟萃分析表明，PMX 治疗对血流动力学、肺氧合和死亡率有有益影响。这些有益效果可能归因于内毒素、单核细胞、活化的中性粒细胞和花生四烯酸的直接吸附以及炎症细胞因子和其他介质的间接减少。聚马菌素 B 固定化纤维柱血液灌流治疗对减轻内皮损伤、促凋亡活性和免疫抑制也有额外的作用。需要进一步的研究来证实 PMX 治疗感染性休克的疗效和机制。
