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血液吸附作为急性呼吸窘迫综合征（ARDS）的辅助治疗：一项系统评价和荟萃分析

Hemoadsorption as Adjuvant Therapy in Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis.

作者信息

Szigetváry Csenge Erzsébet, Turan Caner, Kovács Emőke Henrietta, Kói Tamás, Engh Marie Anne, Hegyi Péter, Csukly Gábor, Ruszkai Zoltán, Molnár Zsolt

机构信息

Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary.

Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.

出版信息

Biomedicines. 2023 Nov 16;11(11):3068. doi: 10.3390/biomedicines11113068.

DOI:10.3390/biomedicines11113068

PMID:38002070

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10669540/

Abstract

BACKGROUND

Acute respiratory distress syndrome (ARDS) is often a consequence of a dysregulated immune response; therefore, immunomodulation by extracorporeal cytokine removal has been increasingly used as an adjuvant therapy, but convincing data are still missing. The aim of this study was to investigate the effects of adjunctive hemoadsorption (HA) on clinical and laboratory outcomes in patients with ARDS.

METHODS

We performed a systematic literature search in PubMed, Embase, CENTRAL, Scopus, and Web of Science (PROSPERO: CRD42022292176). The population was patients receiving HA therapy for ARDS. The primary outcome was the change in PaO2/FiO2 before and after HA therapy. Secondary outcomes included the before and after values for C-reactive protein (CRP), lactate, interleukin-6 (IL-6), and norepinephrine (NE) doses.

RESULTS

We included 26 publications, with 243 patients (198 undergoing HA therapy and 45 controls). There was a significant improvement in PaO2/FiO2 ratio following HA therapy (MD = 68.93 [95%-CI: 28.79 to 109.06] mmHg, = 0.005) and a reduction in CRP levels (MD = -45.02 [95%-CI: -82.64; -7.39] mg/dL, = 0.026) and NE dose (MD = -0.24 [95%-CI: -0.44 to -0.04] μg/kg/min, = 0.028).

CONCLUSIONS

Based on our findings, HA resulted in a significant improvement in oxygenation and a reduction in NE dose and CRP levels in patients treated with ARDS. Properly designed RCTs are still needed.

摘要

背景

急性呼吸窘迫综合征（ARDS）通常是免疫反应失调的结果；因此，通过体外细胞因子清除进行免疫调节已越来越多地用作辅助治疗，但仍缺乏令人信服的数据。本研究的目的是探讨辅助血液吸附（HA）对ARDS患者临床和实验室指标的影响。

方法

我们在PubMed、Embase、CENTRAL、Scopus和Web of Science（PROSPERO：CRD42022292176）中进行了系统的文献检索。研究对象为接受HA治疗的ARDS患者。主要结局是HA治疗前后动脉血氧分压/吸入氧分数值（PaO2/FiO2）的变化。次要结局包括治疗前后C反应蛋白（CRP）、乳酸、白细胞介素-6（IL-6）和去甲肾上腺素（NE）剂量的值。

结果

我们纳入了26篇文献，共243例患者（198例接受HA治疗，45例为对照组）。HA治疗后PaO2/FiO2比值有显著改善（MD = 68.93[95%置信区间：28.79至109.06]mmHg，P = 0.005），CRP水平降低（MD = -45.02[95%置信区间：-82.64；-7.39]mg/dL，P = 0.026），NE剂量降低（MD = -0.24[95%置信区间：-0.44至-0.04]μg/kg/min，P = 0.028）。