慢性透析 SARS-CoV-2 患者的抗炎治疗方法：ATA 还是 PMMA 透析器？

Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?

机构信息

Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.

Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy.

出版信息

Blood Purif. 2023;52(2):210-218. doi: 10.1159/000526319. Epub 2022 Nov 2.

DOI:10.1159/000526319

PMID:36323242

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9782266/

Abstract

INTRODUCTION

High-flux hemodialysis membranes may modulate the cytokine storm of SARS-CoV-2, but their impact on chronic hemodialysis (CHD) patients is unknown. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers and clinical outcomes in CHD patients with SARS-CoV-2.

METHODS

A prospective, observational study on CHD patients with SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021. Pre- and postdialysis C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were determined at each session. Patients who underwent on-line hemodiafiltration (OLHDF) with a PMMA dialyzer were compared with those treated with OLHDF with a ATA dialyzer. The primary endpoint was the differences in the reduction ratio per session (RR) of CRP, PCT, IL-6, and IL-6 RR >25%.

RESULTS

We consecutively enrolled 74 CHD patients with COVID-19, 48 were treated with ATA membrane, and 26 with PMMA. Median IL-6 RR was higher in the ATA group compared to PMMA (17.08%, IQR -9.0 to 40.0 vs. 2.95%, IQR -34.63 to 27.32). Median CRP RR was 7.77% (IQR 2.47-13.77) in the ATA group versus 4.8% (IQR -2.65 to 11.38) in the PMMA group (p = 0.0017). Median PCT-RR% was 77.38% (IQR 70.92-82.97) in ATA group versus 54.59% (IQR 42.62-63.16) in the PMMA group (p < 0.0001). A multiple logistic regression analysis with IL-6 RR >25% as the outcome including the membrane employed, pre-dialysis IL-6, CRP, PCT, and ferritin showed that ATA led to a higher probability to reach the outcome (OR 1.891, 95% CI 1.273-2.840, p = 0.0018) while higher CRP favors the risk of lower IL-6 RR values (OR 0.910, 95% CI 0.868-0.949, p ≤ 0.0001).

CONCLUSIONS

In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile, regarding IL-6 RR, compared to PMMA.

摘要

简介

高通量血液透析膜可能会调节 SARS-CoV-2 的细胞因子风暴，但它们对慢性血液透析（CHD）患者的影响尚不清楚。本研究的目的是评估不对称纤维素三乙酸酯（ATA）和聚甲基丙烯酸甲酯（PMMA）透析器对 SARS-CoV-2 合并 CHD 患者的炎症标志物和临床结局的影响。

方法

对 2020 年 3 月至 2021 年 5 月期间 SARS-CoV-2 合并 CHD 的患者进行前瞻性、观察性研究。每次透析前和透析后测定 C 反应蛋白（CRP）、降钙素原（PCT）和白细胞介素 6（IL-6）。将接受 PMMA 透析器在线血液透析滤过（OLHDF）治疗的患者与接受 ATA 透析器 OLHDF 治疗的患者进行比较。主要终点是 CRP、PCT、IL-6 和 IL-6 RR>25%的每个会话的降低率（RR）的差异。

结果

我们连续纳入了 74 例 COVID-19 合并 CHD 的患者，其中 48 例接受 ATA 膜治疗，26 例接受 PMMA 治疗。ATA 组的中位 IL-6 RR 高于 PMMA 组（17.08%，IQR-9.0 至 40.0 与 2.95%，IQR-34.63 至 27.32）。ATA 组 CRP RR 为 7.77%（IQR 2.47-13.77），PMMA 组为 4.8%（IQR-2.65 至 11.38）（p=0.0017）。ATA 组 PCT-RR%为 77.38%（IQR 70.92-82.97），PMMA 组为 54.59%（IQR 42.62-63.16）（p<0.0001）。以 IL-6 RR>25%为结果的多变量逻辑回归分析，包括使用的膜、透析前 IL-6、CRP、PCT 和铁蛋白，ATA 导致达到结果的可能性更高（OR 1.891，95%CI 1.273-2.840，p=0.0018），而 CRP 升高则有利于降低 IL-6 RR 值的风险（OR 0.910，95%CI 0.868-0.949，p≤0.0001）。