Ueno Takuya, Ikeda Toshiaki, Okihara Masaaki, Akashi Isao, Yokoyama Takayoshi, Kihara Yu, Konno Osamu, Nakamura Yuki, Iwamoto Hitoshi, Ueno Yu, Chandraker Anil
Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Front Med (Lausanne). 2023 Mar 1;10:1042487. doi: 10.3389/fmed.2023.1042487. eCollection 2023.
Early recovery from shock improves prognosis in septic shock patients. We determined whether cytokine modulation by Continuous Renal Replacement Therapy (CRRT) following acute care surgery resulted in stable hemodynamics in them. To investigate our hypothesis, we measured proinflammatory cytokines IL-6, IL-1ra and the coagulation cascade activator plasminogen activator inhibitor-1 (PAI-1) following CRRT with polymyxin B immobilized fiber (PMX-DHP) which has been utilized as an adjuvant treatment option for patients with severe septic shock.
66 septic shock patients requiring 2 h direct hemoperfusion therapy PMX-DHP were included. 36 patients of them also received continuous hemodiafiltration (CHDF) after performing PMX-DHP. Circulatory dynamics and levels of inflammatory mediators, namely IL-6, IL-1ra, and PAI-1 were assessed before, immediately after, and 24 h initiation of PMX-DHP.
Mean Arterial Pressure (MAP) rose intentionally by PMX-DHP just after enforcement 24 h later ( < 0.01). Levels of IL-6, IL-1ra, and PAI-1 significantly decreased after PMX-DHP ( < 0.05) and this trend was observed up to 24 h post initiation of PMX-DHP ( < 0.05). IL-6 modulation by PMX-DHP was enhanced with using CHDF and there was a significant correlation between IL-6 and MAP ( < 0.0001). In addition, levels of Il-6 and PAI-1 showed a significant correlation.
Our data showed employing CRRT as cytokine modulators could be an additional therapeutic strategy to improve septic shock outcomes the crucial role of IL-6 signaling in endothelial dysfunction.
脓毒症休克患者休克的早期恢复可改善预后。我们确定急性护理手术后通过持续肾脏替代疗法（CRRT）进行细胞因子调节是否能使他们的血流动力学稳定。为了研究我们的假设，我们在使用多粘菌素B固定纤维（PMX-DHP）进行CRRT后测量了促炎细胞因子白细胞介素-6（IL-6）、白细胞介素-1受体拮抗剂（IL-1ra）和凝血级联激活剂纤溶酶原激活物抑制剂-1（PAI-1），PMX-DHP已被用作严重脓毒症休克患者的辅助治疗选择。
纳入66例需要进行2小时直接血液灌流治疗PMX-DHP的脓毒症休克患者。其中36例患者在进行PMX-DHP后还接受了持续血液透析滤过（CHDF）。在开始PMX-DHP之前以及开始后立即和24小时评估循环动力学和炎症介质水平，即IL-6、IL-1ra和PAI-1。
在实施PMX-DHP 24小时后，平均动脉压（MAP）有意升高（<0.01）。PMX-DHP后IL-6、IL-1ra和PAI-1水平显著降低（<0.05），并且在开始PMX-DHP后24小时内均观察到这种趋势（<0.05）。使用CHDF可增强PMX-DHP对IL-6的调节作用，并且IL-6与MAP之间存在显著相关性（<0.0001）。此外，IL-6和PAI-1水平显示出显著相关性。
我们的数据表明，采用CRRT作为细胞因子调节剂可能是一种改善脓毒症休克结局的额外治疗策略——IL-6信号在内皮功能障碍中的关键作用。
