Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome

BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.

Direct hemoperfusion with a polymyxin B-immobilized cartridge in intestinal warm ischemia reperfusion

AIM： To investigate the effectiveness of direct hemoperfusion with polymyxin B-immobilized fibers （DHPPMX therapy） on warm ischemia-reperfusion （I/R） injury of the small intestine.METHODS： The proximal jejunum and distal ileum of mongrel dogs were resected. Warm ischemia was performed by clamping the superior mesenteric artery （SMA） and vein （SMV） for 2 h. Blood flow to the proximal small intestine was restored 1 h after reperfusion, and the distal small intestine was used as a stoma. The experiment was discontinued 6 h after reperfusion. The dogs were divided into two groups： the DHP-PMX group （n = 6, DHP-PMX was performed for 180 min; from 10 min prior to reperfusion to 170 rain after reperfusion） and the control group （n = 5）. The rate pressure product （RPP）, SMA blood flow, mucosal tissue blood flow, and intramucosal pH （pHi） were compared between the two groups. The serum interleukin （IL）-10 levels measured 170 min after reperfusion were also compared.RESULTS： The RPP at 6 h after reperfusion was significantly higher in the PMX group than in the control group （12174 ± 1832 mmHg/min vs 8929 ± 1797 mmHg/min, P 〈 0.05）. The recovery rates of the SMA blood flow at I and 6 h after reperfusion were significantly better in the PMX group than in the control group （61%±7% vs 44% ±4%, P 〈 0.05, and 59%±5% vs 35%±5%, P 〈 0.05, respectively）. The recovery rate of the mucosal tissue blood flow and the pHi levels at 6 h after reperfusion were significantly higher in the PMX group （61%±8% vs 31%±3%, P 〈 0.05 and 7.91±0.06 vs 7.69±0.08, P 〈 0.05, respectively）. In addition, the serum IL-IO levels just before DHP-PMX removal were significantly higher in the PMX group than in the control group （1 569 ± 253 pg/mL vs 211± 40 pg/mL, P 〈 0.05）.CONCLUSION： DHP-PMX therapy reduced warm I/R injury of the small intestine. IL-10 may play a role in inhibiting I/R injury during DHP-PMX therapy.

Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

BACKGROUND Polymyxin B hemoperfusion(PMX-HP)has been used as a treatment for intraabdominal septic shock by absorbing and removing endotoxins of gram-negative bacilli.AIM To investigate the clinical efficacy of PMX-HP in patients with gram-negative septic shock who underwent abdominal surgery.METHODS From January 2012 to December 2018,patients who had septic shock secondary to peritonitis were enrolled.They were classified into PMX-HP treated and control groups based on postopreative intervention using PMX-HP.The clinical outcomes were compared using 1:1 propensity score matching methods to balance the overall distribution between the two groups.RESULTS After propensity score matching,40 patients were analyzed(20 patients in the PMX group and 20 patients in the control group).The scores of total Sequential Organ Failure Assessment(SOFA)score,renal SOFA and coagulation SOFA were significantly improved in the PMX group but not in the control group.(from 11.2±5.8 to 4.7±3.5 in PMX group vs 10.0±4.0 to 8.7±7.3 in control group,P=0.047 from 2.6±1.0 to 0.7±1.0 in PMX group vs 2.6±1.5 to 2.8±1.6 in control group,P=0.000,from 1.6±1.5 to 1.3±1.3 in PMX group vs 1.2±1.2 to 2.8±1.8 in control group,P=0.014,respectively).Further,the length of intensive care unit(ICU)stay was significantly shorter in PMX group.However,no statistically significant difference was found in ICU mortality(50%in PMX group vs 50%in control group).CONCLUSION PMX-HP is a feasible adjunct treatment for peritonitis in ICU patients with peritonitis for improved organ impairment and to stabilize hemodynamics.It would be helpful to enhance clinical outcomes especially in patients with complete elimination of the source of gram-negative bacilli infection by surgical procedure accompanied with conventional treatment of sepsis.

Effect of hemoperfusion cartridge on different internal environmental indicators

BACKGROUND:This study aimed to observe the effect of hemoperfusion(HP) cartridge on different internal environment indicators at different time points in patients with acute blood poisoning and to find alternative indicators for the detection of blood poisoning.METHODS:The levels of internal environment indicators(blood pH,P_vCO_2,P_vCO_2,blood lactate,potassium,free calcium,bicarbonate,and blood glucose) before and after HP treatment were recorded for patients with acute poisoning at time points of 30 minutes and 120 minutes.After calculating the difference value 5,the statistical software was used to analyze the statistical difference of the influence caused by HP cartridge at two time points.According to the formula,adsorption rate%=(a-v)/a×100,the adsorption rate of each indicator was calculated respectively.RESULTS:The difference of indicators at different time points in inlet and outlet such as blood glucose,free-calcium,and lactate was statistically significant(P<0.05),but the difference in indicators such as pH,P_vCO_2,P_vO_2,potassium,sodium,and bicarbonate was not statistically significant(P>0.05).CONCLUSION:During HP treatment,the indicators of blood glucose,free-calcium and lactate were significantly affected by HP cartridge,and the effect varies with time.

Effect of hemodialysis combined with hemoperfusion on dialysis efficiency, lipid metabolism and atherosclerosis in patients with uremia

Objective:To study the effect of hemodialysis (HD) combined with hemoperfusion (HP) on dialysis efficiency, lipid metabolism and atherosclerosis in patients with uremia.Methods:A total of 70 patients with uremia who were treated in our hospital between March 2013 and October 2015 were collected and divided into observation group and control group (n=35) according to double-blind randomized control method. Observation group of patients received hemodialysis combined with hemoperfusion, control group of patients received hemodialysis alone, and the treatment lasted for 6 months. After 6 months of intervention, automatic biochemical analyzer was used to detect renal function indexes and lipid metabolism indexes, and the two-dimensional ultrasound was used to quantitatively determine the carotid atherosclerosis parameters.Results:Before intervention, differences in renal function, lipid metabolism and atherosclerosis levels were not statistically significant between two groups of patients;after 6 months of intervention, renal function indexes blood urea nitrogen (BUN), serum creatinine (Scr),β2-microglobulin (β2-MG) and blood uric acid (BUA) levels of observation group were lower than those of control group, lipid metabolism indexes total cholesterol (TC), triglyceride (TG), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) levels were lower than those of control group, and differences between groups were statistically significant;quantitative carotid ultrasound parameters gray-scale median (GSM) of observation group was higher than that of control group, enhanced intensity (EI) and enhanced density (ED) were lower than those of control group, and differences between groups were statistically significant.Conclusion:Hemodialysis combined with hemoperfusion can improve the dialysis efficiency, also reduce lipid metabolism disturbance and delay the formation of atherosclerosis in patients with uremia.

Effects of hemoperfusion combined with sequential dialysis on soluble tumor necrosis factor receptor in patients with diabetic kidney disease

Objective: To observe the effects of hemoperfusion combined with sequential dialysis on soluble tumor necrosis factor receptor in patients with diabetic kidney disease. Methods:A total of 100 patients with diabetic kidney disease who had been seeking treatment in the hospital between May 2015 and July 2017 were selected, and then according to the random number table method, these patients were divided into a control group and an observation group, with 50 cases in each group. The control group was treated with hemodialysis only, whereas the observation group was given hemoperfusion combined with sequential dialysis for treatment. The changes of soluble tumor necrosis factor receptor, oxidant factor and metabolic indexes after 12 weeks of treatment were compared between the two groups. Results: After treatment, the metabolic indexes in the observation group were shown to be lower than the control group, the levels of soluble tumor necrosis factor receptor related indexes in the former group were lower than the control group, and the level of oxidative stress indicators in the former group was shown to be better than the control group, where the differences were statistically significant. Conclusion: For patients with diabetic kidney disease, hemoperfusion combined with sequential dialysis is with significant clinical curative effects, which can effectively relieve their oxidative stress, better control the blood glucose level, significantly improve their renal function and significantly reduce the level of soluble tumor necrosis factor receptor.

Effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning

Objective: To investigate the effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning. Methods: A total of 42 patients with acute paraquat poisoning who were admitted and treated in our hospital between December 2013 and October 2017 were selected as the research subjects, and their therapies were reviewed and used to divide them into the control group (n=20) who received hemoperfusion alone and the combined treatment group (n=22) who received hemoperfusion combined with hemodialysis. The differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were compared between the two groups of patients immediately after admission, after 1 d of treatment and after 3 d of treatment. Results: Immediately after admission, the differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were not statistically significant between the two groups. After 1d of treatment and after 3 d of treatment, kidney function indexes Scr, BUN and β2-MG levels in peripheral blood of combined treatment group were lower than those of control group at corresponding time points respectively;liver function indexes ALT, AST, TB and ALP levels in peripheral blood were lower than those of control group at corresponding time points respectively;lung function indexes PaO2, BE and PCO3- levels in arterial blood were higher than those of control group at corresponding time points respectively whereas PaCO2 levels were lower than those of control group at corresponding time points respectively. Conclusion: Compared with hemoperfusion alone, hemoperfusion combined with hemodialysis is more advantageous in protecting the functions of liver, kidney, lungs and other target organs of patients with acute paraquat poisoning.

Effects of intensive hemoperfusion on the toxin clearance, target organ function and oxidative stress in patient with paraquat poisoning

Objective: To study the effects of intensive hemoperfusion on the toxin clearance, target organ function and oxidative stress in patient with paraquat poisoning. Methods: A total of 56 patients with paraquat poisoning who were treated in the People's Hospital of Hanchuan between November 2013 and January 2017 were reviewed and divided into the control group (n=30) and the intensive hemoperfusion group (n=26). Control group received conventional therapy, and intensive hemoperfusion group received conventional therapy combined with intensive hemoperfusion. The differences in paraquat clearance effect, target organ function and oxidative stress response were compared between the two groups. Results: Serum paraquat level in intensive hemoperfusion group was lower than that in control group, and the paraquat clearance rate was higher than that of control group. Serum pulmonary fibrosis indexes PⅠCP, CⅣ and HA levels in intensive hemoperfusion group were lower than those in control group;serum liver function indexes ALP, STB and ALT levels were lower than those in control group;serum oxidative stress index GSH-Px level was higher than that in control group whereas MDA level was lower than that in control group. Conclusion: Intensive hemoperfusion can significantly improve the paraquat clearance rate, protect the important organ function and suppress the systemic oxidative stress response in patient with paraquat poisoning.

Microencapsulated Hepatocytes Hemoperfusion for the Treatment of Fulminant Hepatic Failure Rats

Hepatocytes were isolated from suckling porcine using modified seglen’s collagenase perfusion technique, and were encapsulated with alginate-polylysine-alginate (APA) microcapsules. Fulminant hepatic failure(FHF) was induced in male SD rats by galactosamine. Hemoperfusion performed 24hErs after galactosamine injection. In vitro culture, both encapsulated hepatocytes and free hepatocytes express the ability to synthesis Albumin, Urea .for 7 days, Encapsulated hepatocytesperfusied with Williams’ E medium was shown to provide albumin, urea synthesis functions in 24hrs. The survival time after treatment of microencapsulated hepatocytes hemoperfusion group was longer than othergroups, and Serum ALT, TBIL levels decreased.

Effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning and influence of it on cholinesterase, dopamine and inflammatory factors

Objective:To investigate effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning (AOPP) and influence of it on cholinesterase, dopamine and inflammatory factors.Methods:A total of 82 cases of AOPP patients treated in our hospital from Sep 2012 to Jul 2016 were selected as subjects. They were randomly divided to be the observation group and the control group, 41 cases for each. For patients in observation group, combined therapy of hemoperfusion (HP) and hemofiltration (HF) were provided. For patients in control group, combined therapy of HP and hemodialysis (HD) were provided. Effects on the two groups of patients were compared. Meanwhile, cholinesterase, dopamine and inflammatory factors levels in different times before and after treatment were compared.Results:Consciousness improvement times and hospitalization times in observation group were significantly lower than in control group. No significant difference showed on fatality rates between the two groups. Before treatment, no significant difference showed on CHE and DE levels between two groups of patients;6 h and 12 h after treatment, CHE average levels in two groups were significantly higher than before treatment in the same group, and levels in observation group at the same phase were significantly higher than in control group;6 h and 12 h after treatment, DA levels in observation group were significantly lower than the same group before treatment, and significantly lower than control group, while 12 h after treatment, DA levels in control group were significantly lower than the same group before treatment. Before treatment, no significant difference showed on serum TGF-β1, TNF-α, IL-6, IL-8 between two groups of patients. After treatment, each index levels in two groups were significantly lower than the same group before treatment, and levels in observation group at the same phase were significantly lower than control group. Conclusion:Effects of blood purification therapy on treating AOPP were worth approving, but effects of HP and HF combined therapy were more significant. In addition, improvement of HP+HF on CHE, DA and inflammatory factors were better than HP+HD.

STRUCTURAL AND ADSORPTION RELATIONSHIP OF MACROPOROUS R ESIN IN HEMOPERFUSION

In order to achieve high adsorption capacity of adsorbents in hemoperfusion,macroporous resins were tailor made with appropriate pore sizes and specific area. This allows the toxin molecules to diffuse freely within the channels ofthe porous resins and rinally reach the adsorption sites.Macroporous resin NK - 107 having small pore size and large Surface area(1086cm2) were synthesized which showed a high adsorption capacity of 82 - 94%for small molecules such as hypnotic and sedative drugs. For the adsorption of middle molecules i. e. Vit B12 or cytochrome C adsorbents having large pore sizes weretailor made. In the case of the adsorption of unconjugated bilirubin which is a verybig molecule, the pore size of the adsorbent should be at least>160A. NK - 110 istailor made with a very big pore size,which have a high adsorption capacity of 87%for bilirubin. DNA immobilized on carbonized resins,which have a porous structurewith a large surface area of 1000m2/g,can adsorb DNA antibody effectively. Resultsfrom animal and clinical trials indicated that the above tailor - made adsorbentshave a high efficacy in the removal of endogenous and exogenous toxins in hemoperfusion.

MXene:An efficient hemoperfusion sorbent for the removal of uremic toxins

MXene,a family of two-dimensional(2D)transition metal carbides and nitrides have attracted extensive interests for many biochemical applications,including tumour elimination,biosensors,and magnetic resonance imaging(MRI).In this article,we firstly discovered that Ti3C2Tx MXene exhibited a highly efficient adsorption capability as hemoperfusion absorbent towards middle-molecular mass and protein bound uremic toxins in the end stage of renal disease(ESRD)treatment.Molecular scale investigations reveal that the high efficiency of MXene for the removal of uremic toxins could be attributed to synergistic effects of physical/chemical adsorption,electrostatic interaction surface of 2D MXene,and transformation of protein secondary structure.2D MXene materials could be used as a new hemoperfusion sorbent with ultrahigh efficiency for removing uremic toxins during the treatment of kidney disease.

Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning:a meta-analysis

Background:Acute severe organophosphorus pesticide poisoning is a common severe emergency in developing countries.Our meta-analysis aimed to clarify the efficacy of hemoperfusion combined with hemodialysis on acute severe organophosphorus pesticide poisoning.Methods:Several databases were searched.After formulating relevant inclusion and exclusion criteria,qualified studies were included,and the data were extracted.The outcome indicators were the success rate of rescue,the time of hospitalization,the incidence of com-plications,the time for the cholinesterase level to return to normal,the coma time,and the atropine dosage.The results were analyzed using risk ratios,weighted mean difference,standard mean difference,and 95%confidence interval.The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies.In terms of statistical methods,we used RevMan software(version 5.3;The Nordic Cochrane Centre,The Cochrane Collaboration,Copenhagen,Denmark)and Stata(versions 14 and 16;StataCorp,College Station,TX,USA)for the data analysis.Results:We included 92 randomized controlled trials with 6899 participants.Compared with the conventional emergency treatment group(CET group),the hemoperfusion group(HP+CET group),and the hemodialysis group(HD+CET group),the use of hemoperfusion combined with hemodialysis based on CET(HP+HD+CET group)significantly increased the success rate of rescue and reduced hos-pitalization time,the incidence of complications,time for cholinesterase level to return to normal,coma time,and atropine dosage.Conclusion:Hemoperfusion combined with hemodialysis is effective in the treatment of acute severe organophosphorus pesticide poi-soning.In the future,more scientifically designed,large-scale,high-quality,multicenter randomized controlled trials are needed to validate this study further.

Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration

Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion （HP） in the treatment of patients with acute 2,4-DNP poisoning. Methods We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP （n=5） and intensive HP （n=9） groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy （UPLC-MS/MS） was used to detect the 2,4-DNP concentration in plasma in this study. Results： The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations （C1） of survivors ranged from 0.25 to 41.88 pg/ml （mean （12.56＋13.93） pg/ml）. A positive correlation existed between initial plasma 2,4-DNP concentration （C1） and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day （R3）, the 3rd to 7th day （R3-7）, and the 1st to 7th day （RT）, were only （53.03±14.04）%, （55.25±10.50）%, and （78.29±10.22）%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3-7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance （P〈0.05）. Simultaneously, the elimination half-life （tl/2） of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance （P〈0.05）. Conclusions： The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.

Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function:A case report

BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.

SLED联合HP对脓毒症合并重症急性肾损伤患者炎性应激、血流动力学参数及肾功能的影响

目的:探讨持续低效血液透析(sustained low-efficiency dialysis,SLED)联合血液灌流(hemoperfusion,HP)对脓毒症合并重症急性肾损伤患者炎性应激、血流动力学参数及肾功能的影响。方法:82例脓毒症合并重症急性肾损伤患者依据随机数据表法分为对照组(n=41)和观察组(n=41),两组患者均给予常规支持治疗,在此基础上对照组患者给予连续性肾脏替代治疗(continuous renal replacement therapy,CRRT),观察组患者给予SLED联合HP治疗。比较治疗前后两组的炎性因子、血液流变学参数及肾功能指标。结果:对照组与观察组治疗前C反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)、平均动脉压(mean arterial pressure,MAP)、氧合指数(oxygenation index,OI)、尿素氮(BUN)、血肌酐(Scr)水平比较差异无统计学意义(P>0.05);与组内治疗前水平相比,治疗后两组CRP、WBC、PCT、BUN、Scr水平均显著降低,MAP、OI水平均显著升高,差异有统计学意义(P<0.05);与对照组治疗后水平相比,治疗后观察组CRP、WBC、PCT、BUN、Scr水平均显著降低,MAP、OI水平均显著升高,差异有统计学意义(P<0.05)。结论:SLED联合HP方案治疗脓毒症合并重症急性肾损伤,可有效抑制机体炎症因子的释放,改善血流动力学及肾功能,具有重要临床价值。

Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis:A retrospective single-center study

BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)has increased yearly,but updated population-based estimates on the incidence of HTG-AP are lacking.Reducing serum triglyceride(TG)levels quickly is crucial in the early treatment of HTG-AP.Decreased serum TG levels are treated by non-invasive methods,which include anti-lipidemic agents,heparin,low-molecular weight heparin,and insulin,and invasive methods,such as blood purification including hemoperfusion(HP),plasmapheresis,and continuous renal replacement therapy.However,authoritative guidelines have not been established.Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.AIM To evaluate the effect between patients treated with intravenous insulin(INS)and HP to guide clinical treatment.METHODS We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021.The inpatient medical and radiologic records were reviewed to determine clinical features,severity,complications,mortality,recurrence rate,and treatment.Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP.Propensity score matching was used to compare the clinical outcomes of INS and HP.RESULTS A total of 371 patients met the HTG-AP criteria.The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years(8.4%in April 2012-March 2013 and 22.3%in April 2020-March 2021).The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years.The amylase level was elevated in 80.1%of patients but was only three times the normal value in 46.9%of patients.The frequency of severe acute pancreatitis(26.9%),organ failure(31.5%),rate of recurrence(32.9%),and mortality(3.0%)of HTG-AP was high.Improved Marshall score,modified computed tomography severity index score,baseline TG,baseline amylase,C-reactive protein(CRP),albumin,aspartate aminotransferase,low-density lipoprotein cholesterol,urea nitrogen,creatinine,calcium,hemoglobin,free triiodothyronine,admission to intensive care unit,and mortality were significantly different between patients with different grades of severity(P<0.050).Multivariate logistic regression analysis confirmed that high CRP[P=0.005,odds ratio(OR)=1.011,95%CI:1.003-1.019],low calcium(P=0.003,OR=0.016,95%CI:0.001-0.239),and low albumin(P=0.023,OR=0.821,95%CI:0.693-0.973)were risk factors of severe HTG-AP.After propensity score matching adjusted by sex,age,severity of HTG-AP,and baseline TG,the serum TG significantly decreased in patients treated with INS(P<0.000)and HP(P<0.000)within 48 h.However,the clearance rate of TG(57.24±33.70%vs 56.38±33.61%,P=0.927)and length of stay(13.04±7.92 d vs 12.35±6.40 d,P=0.730)did not differ between the two groups.CONCLUSION The incidence of HTG-AP exhibited a significant increase,remarkable severity,and recurrent trend.Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

Combined use of non-biological artif icial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome

BACKGROUND:Acute liver failure(ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders,the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artif icial liver treatments for patients with acute liver failure(ALF) complicated by multiple organ dysfunction syndrome(MODS).METHODS:Thirty-one patients with mid- or late-stage liver failure complicated by MODS(score 4) were randomly divided into three treatment groups:plasmapheresis(PE) combined with hemoperfusion(HP) and continuous venovenous hemodiafiltration(CVVHDF),PE+CVVHDF,and HP+CVVHDF,respectively. Heart rate(HR) before and after treatment,mean arterial pressure(MAP),respiratory index(PaO2/FiO2),hepatic function,platelet count,and blood coagulation were determined.RESULTS:Signifi cant improvement was observed in HR,MAP,PaO2/FiO2,total bilirubin(TBIL) and alanine aminotransferase(ALT) levels after treatment(P<0.05). TBIL and ALT decreased more signifi cantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups(P<0.01). Prothrombin time(PT) and albumin were signifi cantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups(P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups(P<0.05). The survival rate of the patients was 58.1%(18/31),viral survival rate 36.4%(4/11),and non-viral survival rate 70%(14/20).CONCLUSION:Liver function was relatively improved after treatment,but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites,especially bilirubin. The survival rate was signifi cantly higher in the patients with non-viral liver failure than in those with viral liver failure.

血液灌流与微泵静脉推注阿托品治疗有机磷中毒效果观察

有机磷农药是有机磷酸酯或硫代磷酸酯类化合物,如过量接触、意外服用等因素均可引起急性中毒。有机磷中毒是临床常见中毒急症,其主要症状为头晕、乏力,重症者神志恍惚,甚至呈现昏迷、阵发性惊厥状态,严重者发生中枢性呼吸衰竭、直至死亡,及时治疗非常关键。目前多采用阿托品静注和血液灌流（hemoperfusion,HP）两种方法救治。

Polymyxin B-immobilized fiber columns:A column to breathe new life into the treatment of interstitial lung disease?

Acute exacerbations of idiopathic pulmonary fibrosis(IPF) is a severe respiratory condition with high mortality rate. Direct hemoperfusion with polymyxin B-immobilized fiber columns(PMX-DHP) was originally introduced for the treatment of septic shock. Application of PMX-DHP to the treatment of acute exacerbations of IPF may improve oxygenation and survival of the patients with the disease. In addition to acute exacerbations of IPF, PMXDHP has been applied to acute respiratory failure fromvarious causes; an amyopathic dermatomyositis patient who developed rapidly progressive interstitial lung disease(ILD) with elevated anti-CADM-140/MDA5 autoantibody and a patient with severe amiodarone pulmonary toxicity. It is also demonstrated that PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive ILDs in a case-control setting. PMX treatment decreases not only various circulating molecules but also inflammatory cells, in particular activated monocytes, producing such mediators. Although the incidence of acute exacerbations of IPF is too low for proper randomization, in order to test the effects of PMX-DHP on the disease, a cohort or casecontrol analytic study needs to be conducted, preferably from more than one center or research group.