Blood Purif. 2018;46(3):228-238. doi: 10.1159/000490234. Epub 2018 Jul 4.
Coupled plasma filtration adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit with a continuous renal replacement therapy. The circuit consists of a plasma filter, a resin/adsorbent cartridge and a haemofilter. It differs from many other types of extracorporeal therapies in that the upper part of the circuit can be considered a "closed loop". In this manner, the plasma separated by the plasma filter passes through an adsorbent cartridge containing a resin with high affinity to many cytokines, mediators and toxins/poisons. After passing through the cartridge, the purified plasma is returned to the patient. The second part of the circuit, the haemofilter, can then be used to remove small toxins that are not adsorbed by the resin or to modulate the patient hematic volume. Although more complex, the use of a plasma-separation step prior to the passage through the resin cartridge offers advantages over adsorption by haemoperfusion. The plasma passes through the resin cartridge with a lower velocity than the blood flow, and this allows better contact time for the toxins with the resin, and more thorough penetration into the resin pores. The adsorption of many toxins is highly dependent on a factor expressed as linear velocity. In addition, the plasma does not contain cells or a very limited number of platelets, allowing less potential activation upon contact with the resin. Although the technique was originally developed for the treatment of sepsis and septic shock, there are many additional applications where there can be an advantage of having access to larger molecular weight toxins (compared to haemofiltration) and avoiding the loss of important physiologic substances such as albumin. Some of these new applications, in patients with or without acute kidney injury, include liver failure, rhabdomyolysis, severe autoimmune exacerbations and poisonings. In this article, we discuss some of the basic principles involved in sorbent technology, and how these may contribute to treatment efficacy, review the actual experiences with CPFA and finally discuss the results of recent human studies and their implications. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=490234.
血浆滤过吸附（CPFA）是一种解毒系统，它将血浆吸附回路与连续肾脏替代疗法相结合。该回路由血浆滤器、树脂/吸附剂筒和血液滤器组成。它与许多其他类型的体外治疗方法不同，因为回路的上部可以被认为是一个“闭环”。通过这种方式，被血浆滤器分离的血浆通过含有对许多细胞因子、介质和毒素/毒物具有高亲和力的树脂的吸附剂筒。通过筒后，净化的血浆被返回到患者体内。回路的第二部分，血液滤器，然后可以用于去除未被树脂吸附的小毒素或调节患者的血液量。尽管更复杂，但在通过树脂筒之前使用血浆分离步骤提供了优于血液灌流吸附的优点。血浆以比血流速度更低的速度通过树脂筒，这允许毒素与树脂有更好的接触时间，并且更彻底地渗透到树脂孔中。许多毒素的吸附高度依赖于以线性速度表示的一个因素。此外，血浆中不含细胞或非常有限数量的血小板，这使得与树脂接触时的潜在激活更少。尽管该技术最初是为治疗脓毒症和感染性休克而开发的，但在许多其他应用中，接触到大分子量毒素（与血液滤过相比）并避免失去重要的生理物质（如白蛋白）可能会有优势。在有或没有急性肾损伤的患者中，其中一些新的应用包括肝功能衰竭、横纹肌溶解症、严重的自身免疫恶化和中毒。在本文中，我们讨论了吸附剂技术中涉及的一些基本原则，以及这些原则如何有助于治疗效果，回顾 CPFA 的实际经验，最后讨论最近的人体研究结果及其意义。Cappuccino with Claudio Ronco 视频期刊俱乐部，网址：http://www.karger.com/?doi=490234。
