多粘菌素B血液灌流治疗间质性肺疾病急性加重期的氧合及血清学标志物变化
Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion.
作者信息
Lee Song-I, Chung Chaeuk, Park Dongil, Kang Da Hyun, Lee Jeong Eun
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-ro, Jung-gu, Daejeon 35015, Korea.
出版信息
J Clin Med. 2022 Apr 28;11(9):2485. doi: 10.3390/jcm11092485.
BACKGROUND
Polymyxin B direct hemoperfusion (PMX-DHP) has been tried in acute exacerbation of interstitial lung disease (AE-ILD) patients and has shown clinical benefit. In this study, we tried to investigate the change in oxygenation and serologic markers after PMX-DHP treatment in AE-ILD patients in Korea.
METHODS
We reviewed the medical records of twenty-two patients who were admitted for AE-ILD and underwent PMX-DHP treatment. Changes in vital signs and laboratory findings before and after treatment were compared and factors related to 90-day mortality were analyzed using the Cox regression model.
RESULTS
Of the 22 included patients, 11 (50%) patients were diagnosed with idiopathic pulmonary fibrosis. In AE-ILD patients treated with PMX-DHP, the 28-day mortality rate was 45.5% and the 90-day mortality rate was 72.7%. The P/F ratio before and after PMX-DHP treatment significantly improved in patients from baseline to 24 h (median (IQR), 116.3 (88.5-134.3) mmHg vs. 168.6 (115.5-226.8) mmHg, = 0.001), and 48 h (116.3 (88.5-134.3) mmHg vs. 181.6 (108.9-232.0) mmHg, = 0.003). Also, white blood cells (WBCs) and C-reactive protein (CRP) were decreased after PMX-DHP treatment. High acute physiology and chronic health evaluation II scores were associated with 90-day mortality.
CONCLUSIONS
In patients with AE-ILD, PMX-DHP treatment was associated with an improved P/F ratio and lower WBC and CRP levels.
背景
多粘菌素B直接血液灌流（PMX-DHP）已在间质性肺病急性加重期（AE-ILD）患者中进行了尝试，并显示出临床益处。在本研究中，我们试图调查韩国AE-ILD患者接受PMX-DHP治疗后氧合和血清学标志物的变化。
方法
我们回顾了22例因AE-ILD入院并接受PMX-DHP治疗的患者的病历。比较治疗前后的生命体征和实验室检查结果，并使用Cox回归模型分析与90天死亡率相关的因素。
结果
在纳入的22例患者中，11例（50%）被诊断为特发性肺纤维化。在接受PMX-DHP治疗的AE-ILD患者中，28天死亡率为45.5%，90天死亡率为72.7%。PMX-DHP治疗前后的P/F比值在患者中从基线到24小时显著改善（中位数（IQR），116.3（88.5-134.3）mmHg对168.6（115.5-226.8）mmHg，P = 0.001），以及48小时（116.3（88.5-134.3）mmHg对181.6（108.9-232.0）mmHg，P = 0.003）。此外，PMX-DHP治疗后白细胞（WBC）和C反应蛋白（CRP）降低。高急性生理学和慢性健康状况评估II评分与90天死亡率相关。
结论
在AE-ILD患者中，PMX-DHP治疗与改善的P/F比值以及更低的WBC和CRP水平相关。
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