Objective To evaluate the impact of hemoperfusion combined with hemofiltration on inflammatory mediators and prognosis in sepsis through meta-analysis. Method A comprehensive literature search was conducted using PubMed, Web of Science, MedLine, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database to collect randomized controlled trials of blood perfusion combined with blood filtration for the treatment of sepsis (observation group treated with blood perfusion combined with blood filtration, control group treated with pure blood filtration). The search was conducted from the establishment of the database until June 30, 2023. Meta-analysis was conducted by using RevMan 5.4 software, and funnel plots were used to analyze the publication bias of various studies. Results A total of 19 articles were included, including 1322 patients. Meta-analysis showed that compared to the control group, the observation group had a lower level of C-reactive protein (SMD=-1.60, 95% CI：-2.02～-1.18, P＜0.001), and a lower level of tumor necrosis factor-α (SMD=-1.60, 95% CI：-1.77～ -1.43, P＜0.001), a lower level of interleukin-6 (SMD=-1.29, 95% CI：-1.43～--1.14, P＜0.001), a lower level of sequential organ failure scores (SMD= -0.74, 95% CI：-0.98, -0.51, P＜0.001), and decreased mortality rates (RR=0.50, 95% CI：0.39～ 0.65, P＜0.001). Conclusion The combination of hemoperfusion and hemofiltration therapy can downregulate the inflammatory mediators in sepsis, reduce SOFA scores and mortality, and improve prognosis.
WU Li-Hong
,
WANG Lin-Hua
,
LUO Li
,
SHI Da-Zhi
. Meta analysis of the effects of hemoperfusion combined with hemofiltration on inflammatory mediators and prognosis in sepsis[J]. Chinese Journal of Blood Purification, 2024
, 23(05)
: 338
-341
.
DOI: 10.3969/j.issn.1671-4091.2024.05.004
参考文献
[1]Evans L，Rhodes A，Alhazzani W，et al. Surviving Sepsis Campaign：International Guidelines for Management of Sepsis and Septic Shock 2021［J］. Crit Care Med，2021，49（11）：e1063- e1143.
[2]Fajgenbaum DC，June CH. Cytokine storm［J］. N Engl J Med， 2020，383（23）：2255-2273.
[3]Villa G , Neri M , Bellomo R , et al. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications[J]. Critical Care, 2016, 20(1):283.
[4]罗凯,汪贤聪,彭梅,等.持续血液滤过联合血液灌流治疗脓毒血症合并急性肾功能衰竭的疗效观察[J]. 中日友好医院学报,2014,28(4):219-221.
[5]李斌,张碧波 .CVVH 联合 HP 治疗重症脓毒血症的疗效及机理研究[J].西南国防医药,2015,25(10):1066-1069.
[6]罗建宇，王晓源，吕光宇，等． 血液灌流联合连续性血液滤过在脓毒症患者中的临床应用观察［J］． 临床肾脏病杂志，2019，19( 3) : 157 － 161．
[7]赵琳琳，田园，韩淑苗，等． CＲＲT 联合 HA330 血液灌流治疗对脓毒症患者细胞因子水平及近期生存率的影响［J］． 广东医学，2018，39( 21) : 3211 － 3215．
[8]徐艳梅，许传文.血液灌流联合连续性血液滤过治疗脓毒血症并急性肾损伤的疗效观察［J］. 广东医学，2012，33（23）: 3615-3618.
[9]郑文娟，斯小水，何建新，等 .持续静脉 - 静脉血液滤过联合血液灌流在重症脓毒血症患者治疗中对炎性因子及器官功能的影响[J].全科医学临床与教育，2014，12（6）：619-622.
[10]唐怡，张凌，杨莹莹，等.血液灌流联合连续性静脉 - 静脉血液滤过治疗脓毒血症合并急性肾损伤的疗效分析[J].西部医学，2012，24（2）：233-235.
[11]李彦嫦 .CRRT 联合灌流在脓毒症休克患者中的疗效观察及安全性研究 [J]. 内蒙古医学杂志，2017，49（2）：156-158.
[12]鞠 涛. 血液灌流联合血液滤过治疗脓毒症休克临床疗效分析[J].中国急救医学，2017,37（11）:16-17.
[13]林华新，容永璋，莫玉华.早期持续高容量血液滤过联合血液灌流治疗严重脓毒症的疗效观察[J].现代中西医结合杂志，2014 ，23( 26)：2937-3938.
[14]李本通，朱从建，龚军. 床旁持续血液滤过联合血液灌流治疗感染性休克患者的效果及对血流动力学和炎性因子的影响[J]. 广东医学，2020，41（14）：1470-1474.
[15]张彦峰，罗伟雄，罗伟文.连续性静脉-静脉血液滤过联合血液灌流治疗严重脓毒症临床研究[J]. 中国实用内科杂志，2016，36(1):57-59.
[16]卫科科.连续性血液滤过联合血液灌流治疗对ICU脓毒症患者疗效的影响[J].当代医学,2019, 25 (26):171-172.
[17]陈咏梅, 韩从华,许文娟，等.血液灌流联合连续性血液滤过治疗脓毒症的疗效观察[J].中国医学创新，2020，17（1）：32-35.
[18]谢飞，周美兰.血液灌流与床旁间歇性血液净化联合治疗对脓毒症患者预后的影响[J].中国中西医结合肾病杂志，2021，22（10）：886-888.
[19]康阳阳.连续性肾替代疗法联合血液灌流治疗脓毒症的临床观察[J].现代诊断与治疗，2020，31（20）：3265-3266.
[20]黎英，黄杰，林华权.HP联合CVVH治疗脓毒性休克的临床分析[J].中国现代药物应用，2019，13(2):69-70.
[21]马亮.连续性静脉-静脉血液滤过联合血液灌流治疗ICU脓毒症患者的效果观察[J].医学信息,2021, 34 (13) :107-109.
[22]朱晴，张逸雪，刘洋，等.脓毒症的病理生理机制研究进展[J].中华医院感染学杂志，?2022，32(16)：2551-2555.
[23]Alcamo A,Pang D,Bashir D,et al.Role of Damage-Associated Molecular Patterns and Uncontrolled Inflammation in Pediatric Sepsis-Induced Multiple Organ Dysfunction Syndrome[J].Journal of Pediatric Intensive Care,2019,8(1):25-31.
[24]Ronco C , Tetta C , Mariano F , et al. Interpreting the Mechanisms of Continuous Renal Replacement Therapy in Sepsis: The Peak Concentration Hypothesis[J]. Artificial Organs, 2015, 27(9):792-801.
[25]De Vriese AS，Colardyn FA，Philppe JJ，et al．Cytokine removal during continuous hemofiltration in sepsis patoents［J］． J Am Sol Nephrol， 1999，10（4）: 846-853.
[26]Hassan J , Cader R A , Kong N C , et al. Coupled Plasma Filtration Adsorption (CPFA) plus Continuous Veno-Venous Haemofiltration (CVVH) versus CVVH alone as an adjunctive therapy in the treatment of sepsis[J]. EXCLI Journal, 2013, 12（12）:681-692.
[27]?Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-710.
