多粘菌素B固定化纤维直接血液灌流对间质性肺疾病急性加重患者的影响。
The effects of direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute exacerbation of interstitial lung disease.
作者信息
Lee Jae Ha, Park Jin Han, Kim Hyo-Jung, Kim Hyun Kuk, Jang Ji Hoon, Kim Yong Kyun, Park Bong Soo, Park Si Hyung, Kim Il Hwan, Kim Se Hun, Heo Woon, Jang Hang-Jea
机构信息
Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
出版信息
Acute Crit Care. 2021 May;36(2):126-132. doi: 10.4266/acc.2021.00073. Epub 2021 Apr 15.
BACKGROUND
Acute exacerbation of interstitial lung disease (AE-ILD) causes clinically significant deterioration and has an extremely poor prognosis with high mortality. Recently, several studies reported the effectiveness of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) in patients with AE-ILD as a potential therapy. This study describes the clinical effectiveness and safety of PMX-DHP in patients with AE-ILD.
METHODS
We retrospectively reviewed the medical records of 10 patients (11 episodes) with AE-ILD treated with PMX-DHP from January 2018 to June 2019. We compared laboratory and physiologic data of the ratio of partial pressure arterial oxygen to fraction of inspired oxygen (P/F ratio) and level of inflammatory markers before and after implementation of PMX-DHP.
RESULTS
Ten patients were included according to the 2016 revised definition of acute exacerbation of idiopathic pulmonary fibrosis (IPF). Nine patients had IPF and one patient had fibrotic nonspecific interstitial pneumonia. Most patients (90.9%) were treated with a steroid pulse, and four patients (36.4%) were treated with an immunosuppressant. The median number of PMX-DHP cycles was 2, and the median duration of each cycle was 6 hours. After PMX-DHP, the mean P/F ratio improved (86 [range, 63-106] vs. 145 [86-260], P=0.030) and interleukin-6 and c-reactive protein decreased (79 [35-640] vs. 10 [5-25], P=0.018 and 14 [4-21] vs. 5 [2-6], P=0.019, respectively). The 30-day mortality rate was 27.3% and the 90-day mortality rate was 72.7%.
CONCLUSIONS
PMX-DHP treatment improved P/F ratio and reduced inflammatory markers in AE-ILD patients.
背景
间质性肺病急性加重（AE-ILD）会导致临床上显著的病情恶化，预后极差，死亡率很高。最近，多项研究报告了使用多粘菌素B固定纤维柱直接血液灌流（PMX-DHP）对AE-ILD患者作为一种潜在治疗方法的有效性。本研究描述了PMX-DHP在AE-ILD患者中的临床有效性和安全性。
方法
我们回顾性分析了2018年1月至2019年6月期间接受PMX-DHP治疗的10例AE-ILD患者（11个疗程）的病历。我们比较了实施PMX-DHP前后动脉血氧分压与吸入氧分数之比（P/F比）的实验室和生理数据以及炎症标志物水平。
结果
根据2016年特发性肺纤维化（IPF）急性加重的修订定义纳入了10例患者。9例患者患有IPF，1例患者患有纤维化非特异性间质性肺炎。大多数患者（90.9%）接受了类固醇冲击治疗，4例患者（36.4%）接受了免疫抑制剂治疗。PMX-DHP的中位疗程数为2个，每个疗程的中位持续时间为6小时。PMX-DHP治疗后，平均P/F比有所改善（86[范围为63-106]对145[86-260]，P=0.030），白细胞介素-6和C反应蛋白降低（分别为79[35-640]对10[5-25]，P=0.018和14[4-21]对5[2-6]，P=0.019）。30天死亡率为27.3%，90天死亡率为72.7%。
结论
PMX-DHP治疗改善了AE-ILD患者的P/F比并降低了炎症标志物水平。
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