细胞因子吸附器Cytosorb®对严重横纹肌溶解症患者的肌红蛋白吸附及饱和动力学：一项前瞻性试验
Myoglobin adsorption and saturation kinetics of the cytokine adsorber Cytosorb® in patients with severe rhabdomyolysis: a prospective trial.
作者信息
Graf Helen, Gräfe Caroline, Bruegel Mathias, Zoller Michael, Maciuga Nils, Frank Sandra, Weidhase Lorenz, Paal Michael, Scharf Christina
机构信息
Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany.
Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
出版信息
Ann Intensive Care. 2024 Jun 22;14(1):96. doi: 10.1186/s13613-024-01334-x.
BACKGROUND
Rhabdomyolysis is a serious condition that can lead to acute kidney injury with the need of renal replacement therapy (RRT). The cytokine adsorber Cytosorb® (CS) can be used for extracorporeal myoglobin elimination in patients with rhabdomyolysis. However, data on adsorption capacity and saturation kinetics are still missing.
METHODS
The prospective Cyto-SOLVE study (NCT04913298) included 20 intensive care unit patients with severe rhabdomyolysis (plasma myoglobin > 5000 ng/ml), RRT due to acute kidney injury and the use of CS for myoglobin elimination. Myoglobin and creatine kinase (CK) were measured in the patient´s blood and pre- and post-CS at defined time points (ten minutes, one, three, six, and twelve hours after initiation). We calculated Relative Change (RC, %) with: [Formula: see text]. Myoglobin plasma clearances (ml/min) were calculated with: [Formula: see text] RESULTS: There was a significant decrease of the myoglobin plasma concentration six hours after installation of CS (median (IQR) 56,894 ng/ml (11,544; 102,737 ng/ml) vs. 40,125 ng/ml (7879; 75,638 ng/ml) (p < 0.001). No significant change was observed after twelve hours. Significant extracorporeal adsorption of myoglobin can be seen at all time points (p < 0.05) (ten minutes, one, three, six, and twelve hours after initiation). The median (IQR) RC of myoglobin at the above-mentioned time points was - 79.2% (-85.1; -47.1%), -34.7% (-42.7;-18.4%), -16.1% (-22.1; -9.4%), -8.3% (-7.5; -1.3%), and - 3.9% (-3.9; -1.3%), respectively. The median myoglobin plasma clearance ten minutes after starting CS treatment was 64.0 ml/min (58.6; 73.5 ml/min), decreasing rapidly to 29.1 ml/min (26.5; 36.1 ml/min), 16.1 ml/min (11.9; 22.5 ml/min), 7.9 ml/min (5.5; 12.5 ml/min), and 3.7 ml/min (2.4; 6.4 ml/min) after one, three, six, and twelve hours, respectively.
CONCLUSION
The Cytosorb® adsorber effectively eliminates myoglobin. However, the adsorption capacity decreased rapidly after about three hours, resulting in reduced effectiveness. Early change of the adsorber in patients with severe rhabdomyolysis might increase the efficacy. The clinical benefit should be investigated in further clinical trials.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04913298. Registered 07 May 2021, https//clinicaltrials.gov/study/NCT04913298.
背景
横纹肌溶解是一种严重病症，可导致急性肾损伤，需要进行肾脏替代治疗（RRT）。细胞因子吸附器Cytosorb®（CS）可用于横纹肌溶解患者的体外肌红蛋白清除。然而，关于吸附能力和饱和动力学的数据仍然缺失。
方法
前瞻性Cyto-SOLVE研究（NCT04913298）纳入了20名重症监护病房中患有严重横纹肌溶解（血浆肌红蛋白>5000 ng/ml）、因急性肾损伤接受RRT且使用CS进行肌红蛋白清除的患者。在患者血液以及CS治疗前和治疗后特定时间点（开始治疗后10分钟、1小时、3小时、6小时和12小时）测量肌红蛋白和肌酸激酶（CK）。我们用以下公式计算相对变化（RC，%）：[公式：见原文]。肌红蛋白血浆清除率（ml/min）用以下公式计算：[公式：见原文] 结果：安装CS后6小时，肌红蛋白血浆浓度显著下降（中位数（四分位间距）56,894 ng/ml（11,544；102,737 ng/ml）对比40,125 ng/ml（7879；75,638 ng/ml）（p<0.001）。12小时后未观察到显著变化。在所有时间点均可见肌红蛋白的显著体外吸附（p<0.05）（开始治疗后10分钟、1小时、3小时、6小时和12小时）。上述时间点肌红蛋白的中位数（四分位间距）RC分别为-79.2%（-85.1；-47.1%）、-34.7%（-42.7；-18.4%）、-16.1%（-22.1；-9.4%）、-8.3%（-7.5；-1.3%）和-3.9%（-3.9；-1.3%）。开始CS治疗10分钟后的肌红蛋白血浆清除率中位数为64.0 ml/min（58.6；73.5 ml/min），1小时、3小时、6小时和12小时后分别迅速降至29.1 ml/min（26.5；36.1 ml/min）、16.1 ml/min（11.9；22.5 ml/min）、7.9 ml/min（5.5；12.5 ml/min）和3.7 ml/min（2.4；6.4 ml/min）。
结论
Cytosorb®吸附器可有效清除肌红蛋白。然而，吸附能力在约3小时后迅速下降，导致有效性降低。在严重横纹肌溶解患者中早期更换吸附器可能会提高疗效。临床获益应在进一步的临床试验中进行研究。
试验注册
ClinicalTrials.gov NCT04913298。于2021年5月7日注册，https//clinicaltrials.gov/study/NCT04913298。
Zotero 插件