多粘菌素B血液灌流固定化纤维柱直接血液灌流(polymyxin B hemoperfusion immobilized fiber column direct hemoperfusion，PMX-DHP)的内毒素吸附治疗已用于脓毒症休克患者的治疗。内毒素是革兰氏阴性菌的外膜成分，在脓毒症休克的发病机制中起着重要作用。内毒素触发白细胞、巨噬细胞和内皮细胞分泌各种信号级联介质，包括细胞因子和一氧化氮，导致脓毒症休克和多器官功能障碍综合征。PMX-DHP不仅直接吸附内毒素，还直接吸附单核细胞和单酰胺。它可降低血液中炎症细胞因子的水平，如白细胞介素(IL)-1、IL-6、肿瘤坏死因子-α和IL-17A、粘附分子、纤溶酶原激活剂抑制剂1和高迁移率组box-1；增加血压，降低血管活性肌力药物的剂量。PMX-DHP可以改善严重脓毒症和脓毒症休克患者单核细胞人白细胞抗原-dr的表达。本文就PMX-DHP治疗脓毒症休克的研究进展进行综述。
Endotoxin adsorption therapy with polymyxin B hemoperfusion immobilized fiber column direct hemoperfusion (PMX-DHP) has been used in the treatment of septic shock. Endotoxin is an outer membrane component of Gram-negative bacteria, and plays an important role in the pathogenesis of septic shock. Endotoxin triggers white blood cells, macrophages and endothelial cells to secrete a cascade of signaling mediators including cytokines and nitric oxide, leading to septic shock and multiple organ dysfunction syndrome. PMX-DHP directly adsorbs endotoxin as well as monocytes and monoamides, and reduces blood levels of inflammatory cytokines such as IL-1, IL-6, tumor necrosis factor-α, IL-17A, adhesion molecules, plasminogen activator inhibitor-1, and high mobility group box-1 (HMGB1). PMX-DHP also elevates blood pressure, lowers the dose of vasoactive inotropic drugs, and improves the expression of HLA-DR on monocytes in patients with severe sepsis and septic shock. This article reviews the research progresses in PMX-DHP used in the treatment of septic shock.
[1] SAETANG, PATCHARIN, SAMRANSAMRUAJKIT, et al. Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series [J]. Pediatric Critical Care Medicine, 2022, 23(8): e386-e391.
[2] SHIMIZU T, MIYAKE T, KITAMURA N, et al. Endotoxin adsorption: Direct hemoperfusion with the polymyxin B-immobilized fiber column (PMX) [J]. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis, 2017, 56(5): 682-8.
[3] NAKAMURA T, KAWAGOE Y, SUZUKI T, et al. Polymyxin B-immobilized fiber hemoperfusion with the PMX-05R column in elderly patients suffering from septic shock [J]. The American journal of the medical sciences, 2007, 334(4): 244-7.
[4] LAN J. Clinical Observation of Integrated Chinese and Western Medicine Therapy for Low Birth Weight Infants with Jaundice [J]. Journal of New Chinese Medicine, 2021，Nov 8;2021:6366914.
[5] KOHEI U, AKIHIKO O, KINYA H, et al. Endotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock [J]. 2002;39(5):937-947.,
[6] YAMATO M, ASAHINA Y, KOIZUMI S, et al. Lactate predicts the 28-day survival rate in patients with septic shock treated with the combination of PMX-DHP and rTM [J]. Therapeutic Apheresis and Dialysis, 2020, 24(5): 492-8.
[7] Oshima K, Akao T, Kobayashi K, Muraoka M, Matsumoto K, Takeyoshi I. The effect of direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX therapy) on pulmonary ischemia-reperfusion injury in a canine model [J]. J Invest Surg. 2008;21(3):127-132.
[8] ROMASCHIN A D, C.V. O-F, H. S, et al. Novel Insights into the Direct Removal of Endotoxin by Polymyxin B Hemoperfusion [J]. Blood Purif, 2017,;44(3):193-197.
[9] YAMASHITA C, MORIYAMA K, HASEGAWA D, et al. In Vitro Study of Endotoxin Adsorption by a Polymyxin B-Immobilized Fiber Column [J]. Blood Purif, 2018, 46(4): 269-73.
[10] NISHIBORI M, TAKAHASHI H K, KATAYAMA H, et al. Specific Removal of Monocytes from Peripheral Blood of Septic Patients by Polymyxin B-immobilized Filter Column [J]. Acta medica Okayama, 2009, 63(1): 65-9.
[11] ASAKAWA K, TAKADA T, MEDICINE D, et al. Polymyxin B-immobilized fiber columns:A column to breathe new life into the treatment of interstitial lung disease? [J]. World Journal of Respirology, 2015, March 28; 5(1): 1-3
[12] MASAMITSU, UBUKATA, MASAKI, et al. Early initiation of direct hemoperfusion with a polymyxin B-immobilized fiber column for the acute exacerbation of interstitial pneumonia [J]. J Artif Organs. 2017 Mar;20(1):71-75..
[13] MITAKA C, KUSAO M, KAWAGOE I, et al. Impact of Extended Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion on Hemodynamics, Vasoactive Substance Requirement, and Pulmonary Oxygenation in Patients with Sepsis: An Observational Study [J]. Blood Purif, 2022, 51(1): 62-9.
[14] YAMASHITA C, HARA Y, KURIYAMA N, et al. Clinical Effects of a Longer Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion Therapy for Severe Sepsis and Septic Shock [J]. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 2015, 19(4): 316-23.
[15] CHIZURU, YAMASHITA, KAZUHIRO, et al. Safety of sustained polymyxin B-immobilized fiber column direct hemoperfusion in patients with abdominal sepsis [J]. Journal of Japan Society for Surgical Infection, 2018, 15(3):216-220.
[16] COUDROY, REMI, PAYEN, et al. Modulation by Polymyxin-B Hemoperfusion of Inflammatory Response Related to Severe Peritonitis [J]. Shock.2017 Jan;47(1):93-99.
[17] SCHADLER D, PAUSCH C, HEISE D, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial [J]. PloS one, 2017, 12(10): e0187015.
[18] SRISAWAT N, TUNGSANGA S, LUMLERTGUL N, et al. The effect of polymyxin B hemoperfusion on modulation of human leukocyte antigen DR in severe sepsis patients [J]. Critical care, 2018, 22(1): 279.
[19] ENOMOTO N, SUDA T, UTO T, et al. Possible therapeutic effect of direct haemoperfusion with a polymyxin B immobilized fibre column (PMX-DHP) on pulmonary oxygenation in acute exacerbations of interstitial pneumonia [J]. Respirology. 2008;13(3):452-460.
[20] Kuwana T, Kinoshita K, Hirabayashi M, et al. PMX-DHP Therapy for Dyspnea and Deoxygenation in Severe COVID-19 Pneumonia: A Case Series [J]. Infect Drug Resist. 2021;14:1305-1310.
[21] BODEGOM-VOS L V, ZIJDEMAN T M, NELISSEN R G H H. Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial [J]. BMJ Quality And Safety, 2022, 43(N): 701-12.
