Takahashi G, Hoshikawa K, Matsumoto N, Shozushima T, Onodera C, Kan S, Akitomi S, Kikkawa T, Tomisawa Y, Kojika M, Sato N, Inoue Y, Suzuki K, Wakabayashi G, Endo S
Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Morioka, Japan.
Eur Surg Res. 2011;47(3):135-40. doi: 10.1159/000330448. Epub 2011 Sep 13.
Endotoxin (Et) adsorption therapy with a column of polymyxin B-immobilized fibers (PMX) is effective in improving the partial pressure of arterial oxygen/fraction of inspired oxygen ratio (PaO(2)/FiO(2) ratio) and increasing mean arterial blood pressure (MAP) in sepsis. S100A12 and soluble receptor for advanced glycation end product (sRAGE) are useful as early markers of acute lung injury.
To investigate the effect of improving the PaO(2)/FiO(2) ratio by PMX-direct hemoperfusion (PMX-DHP) on production of S100A12 and sRAGE.
Sepsis patients after surgery for perforation of the lower gastrointestinal tract were adopted as the subjects. We retrospectively reviewed the cases of 20 patients on mechanical ventilation and continuous administration of norepinephrine. We recorded PaO(2)/FiO(2) ratio, MAP, and norepinephrine doses. S100A12, sRAGE, and Et levels were measured before and after PMX-DHP.
The PaO(2)/FiO(2) ratio and MAP improved significantly after PMX-DHP (p < 0.05). S100A12 and Et decreased significantly after PMX-DHP (p < 0.05). No differences were observed in sRAGE.
S100A12 is useful as a marker that reflected improvement in the PaO(2)/FiO(2) ratio after PMX-DHP. We consider PMX-DHP to be useful as adjunctive therapy for sepsis that reduces the Et and corrects the pathology in the early stage.
使用多粘菌素B固定化纤维柱（PMX）进行内毒素（Et）吸附治疗可有效改善脓毒症患者的动脉血氧分压/吸入氧分数比（PaO₂/FiO₂ 比）并提高平均动脉血压（MAP）。S100A12和晚期糖基化终产物可溶性受体（sRAGE）可作为急性肺损伤的早期标志物。
研究通过PMX直接血液灌流（PMX-DHP）改善PaO₂/FiO₂ 比对S100A12和sRAGE产生的影响。
以下消化道穿孔术后的脓毒症患者为研究对象。我们回顾性分析了20例接受机械通气并持续使用去甲肾上腺素的患者病例。记录PaO₂/FiO₂ 比、MAP和去甲肾上腺素剂量。在PMX-DHP前后测量S100A12、sRAGE和Et水平。
PMX-DHP后PaO₂/FiO₂ 比和MAP显著改善（p < 0.05）。PMX-DHP后S100A12和Et显著降低（p < 0.05）。sRAGE未观察到差异。
S100A12可作为反映PMX-DHP后PaO₂/FiO₂ 比改善情况的标志物。我们认为PMX-DHP作为脓毒症的辅助治疗手段，可在早期降低Et并纠正病理状态，具有一定作用。
