脓毒症急性肾损伤血液净化治疗的现状与展望

Current situation and outlook of blood purification therapy for acute kidney injury in sepsis

血液净化是脓毒症急性肾损伤的主要治疗手段,包括替代肾脏功能的肾脏替代治疗和以调节免疫反应为主的非肾脏替代治疗。血液净化治疗的现状并不乐观,尤其是血液灌流,通过非选择性吸附清除血循环中的炎症介质以期达到降低炎症反应、调节免疫反应的目的,不仅没有改善生存反而带来伤害。相应地,选择性吸附,如多黏菌素B血液灌流柱、清除有害物质同时补充有益物质的血浆置换略胜一筹,但是证据等级较低,需要高质量的研究进一步证实。基于现状,选择合适的时机、患者人群、治疗靶点和研究终点及血液净化设备自身优化,是目前正在着手和今后的研究方向。

Blood purification is the primary treatment for septic acute kidney injury,including renal replacement therapy aimed at replacing the kidney with reduced function and non-renal replacement therapy aimed at modulating the immune response mainly.The current situation of blood purification treatment is not optimistic,especially the treatment of hemoperfusion,which removes inflammatory mediators in blood circulation through non-selective adsorption in the hope of reducing inflammatory response and regulating immune response;however,it not only does not improve survival but brings harm.Accordingly,selective adsorption,such as PMX,and plasmapheresis with removal of harmful substances and supplementation of beneficial substances,is somewhat better,but the level of evidence is low and needs to be further confirmed by high-quality studies.Based on the current situation,the selection of the right time,patient population,therapeutic targets and research endpoints,as well as the optimization of blood purification equipment itself,is currently being done and is also the future research directions.