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Up-to-date information on polymyxin B-immobilized fiber column direct hemoperfusion for septic shock

机译：多辛B - 固定化纤维柱直接血液灌注的最新信息

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Endotoxin adsorption therapy by polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) has been used for the treatment of septic shock patients. Endotoxin, an outer membrane component of Gram-negative bacteria, plays an important role in the pathogenesis of septic shock. Endotoxin triggers a signaling cascade for leukocytes, macrophage, and endothelial cells to secrete various mediators including cytokines and nitric oxide, leading to septic shock and multiple organ dysfunction syndrome. PMX-DHP directly adsorbed not only endotoxin but also monocytes and anandamide. It reduced blood levels of inflammatory cytokines such as interleukin (IL)-1, IL-6, tumor necrosis factor-alpha and IL-17A, adhesion molecules, plasminogen activator inhibitor 1, and high mobility group box-1. As a result, PMX-DHP increased blood pressure and reduced the dose of vasoactive-inotropic agents. PMX-DHP improved monocyte human leukocyte antigen-DR expression in patients with severe sepsis and septic shock. A post hoc analysis of EUPHRATES (Evaluating the Use of Polymyxin B Hemoperfusion in Randomized Controlled Trial of Adults Treated for Endotoxemia and Septic Shock) trial has shown that PMX-DHP significantly reduced 28-day mortality compared with the control group in septic shock patients with endotoxin activity assay level between 0.60 and 0.89. Longer duration of PMX-DHP may be another strategy to bring out the beneficial effects of PMX-DHP. Further studies are needed to confirm the efficacy of PMX-DHP treatment for septic shock.
机译：用多羟辛B-固定化纤维柱直接血液灌注（PMX-DHP）的内毒素吸附治疗已被用于治疗脓毒症休克患者。内毒素是革兰氏阴性细菌的外膜组分，在脓毒症休克发病机制中起重要作用。内毒素触发了用于白细胞，巨噬细胞和内皮细胞的信号级联，分泌各种介质，包括细胞因子和一氧化氮，导致脓肠梗阻和多器官功能障碍综合征。 PMX-DHP不仅吸附了内毒素，还直接吸附着单核细胞和一团。它降低了炎症细胞因子的血液水平，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和高迁移率组箱-1。结果，PMX-DHP增加了血压并降低了血管活性型药剂的剂量。 PMX-DHP改善了严重脓毒症和脓毒症休克患者患者的单核细胞人白细胞抗原-stabl。幼牙的后HOC分析（评估用于内毒素治疗的成人随机对照试验的多粘素B血液灌注）试验表明，与脓毒症休克患者的对照组相比，PMX-DHP显着降低了28天的死亡率内毒素活性测定水平在0.60和0.89之间。 PMX-DHP的较长持续时间可能是另一种策略，以发出PMX-DHP的有益效果。需要进一步的研究来确认PMX-DHP治疗对脓毒症休克的疗效。

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