Cytokine-adsorbing hemofilter AN69ST hemofilter Acute Care Kazuhiro MORIYAMA, Noriko ONOZUKA, Hidehito TSUNASHIMA 1. はじめに 1) CRRT AN69ST 2) sepxiris 2014 7 1 2 AN69ST 2. AN69 膜の開発経緯 1960 1969 著者連絡先 Acute Care 105-6320 1-23-1 E-mail. kazuhiro_moriyama@baxter.com AN69 AN69 図 1 AN69 3) 5) AN69 PAN PAN 6) 3. AN69ST 膜の開発 AN69ST AN69 7 8 6),7),9) 図 2 4. AN69ST 膜の構造 ハイドロゲル構造 AN69 AN69ST 70 accessibility 2) 233
図 1 AN69 図 2 AN69ST 図 3 high mobility group box 1 HMGB1 10),11) HMGB1 CL PMMA hemofilter 25 ml/min AN69ST hemofilter 60 ml/min PMMA hemofilter TMP AN69ST hemofilter TMP PMMA 12) AN69ST 13) 図 3 14) RENAL study AN69 hemofilter 50 2,700 ml/h 24 15) 5. AN69ST 膜の特性 イオン結合によるサイトカイン吸着 16) 5 10 PMMA 234
図 3 図 4 AN69 AN69ST 図 4 7) 6. 血液濾過によるサイトカインの除去 濾過の限界と吸着の優位性 3 20 30 kd CL 14),17) AN69ST HMGB1 CL 60 ml/min 17 ml/min 10),11) CL 14) 1),14),18) 19),20) 235
表 1 1 2 15),21) oxiris NCT01948778 7. セプザイリスの治験成績と保険適用 Surviving Sepsis Campaign guidelines SSCG 2012 22) 23) CRRT non-renal indication 18),23),24) 24) 4 mmol/l 28 34 APACHE 32.7 APACHE 20.3 28 73.5 25) SSCG 26) 25) 6 表 1 2014 7 8. おわりに AN69ST 利益相反の開示 文献 1) Cytokine Adsorbing Hemofilter-CHDF -up-to-date 2011 2: 143-51, 2011 2) Thomas M, Moriyama K, Ledebo I: AN69: Evolution of the world s first high permeability membrane. Contrib Nephrol 173: 119-29, 2011 3) Peng Y, Yuan Z, Li H: Removal of inflammatory cytokines and endotoxin by veno-venous continuous renal replacement therapy for burned patients with sepsis. Burns 31: 623-8, 2005 4) Dahaba AA, Elawady GA, Rehak PH, et al: Procalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care 30: 269-74, 2002 5) Peng Z, Pai P, Hong-Bao L, et al: The impacts of continuous veno-venous hemofiltration on plasma cytokines and monocyte human leukocyte antigen-dr expression in septic patients. Cytokine 50: 186-91, 2010 6) PAN polyacrylonitrile 2012, 73-7 7) Chanard J, Lavaud S, Paris B, et al: Assessment of heparin binding to the AN69 ST hemodialysis membrane: I. preclinical studies. ASAIO J 51: 342-7, 2005 8) Désormeaux A, Moreau ME, Lepage Y, et al: The effect of electronegativity and angiotensin-converting enzyme inhibition on the kinin-forming capacity of polyacrylonitrile dialysis membranes. Biomaterials 29: 1139-46, 2008 9) Lavaud S, Canivet E, Wuillai A, et al: Optimal anticoagulation strategy in haemodialysis with heparin-coated 236
polyacrylonitrile membrane. Nephrol Dial Transplant 18: 2097-104, 2003 10) high mobility group box 1 HMGB1 2: 97-103, 2011 11) Yumoto M, Nishida O, Moriyama K, et al: In vitro evaluation of high mobility group box 1 protein removal with various membranes for continuous hemofiltration. Ther Apher Dial 15: 385-93, 2011 12) Yamashita AC, Tomisawa N: Importance of membrane materials for blood purification devices in critical care. Transfus Apher Sci 40: 23-31, 2009 13) HMGB1 31: 148-55, 2012 14) alarmin high mobility group box 1 protein HMGB1 2: 52-60, 2011 15) RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al: Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 361: 1627-38, 2009 16) Rimmelé T, Kellum JA: High-volume hemofiltration in the intensive care unit: a blood purification therapy. Anesthesiology 116: 1377-87, 2012 17) Moriyama K, Soejima Y: Continuous hemodiafiltration using PMMA membrane: clinical efficacy and its mechanisms. Contrib Nephrol 125: 222-32, 1999 18) 17: 479-89, 2010 19) 37: 56-61, 2008 20) Matsuda K, Moriguchi T, Harii N, et al: Comparison of efficacy between continuous hemodiafiltration with a PMMA membrane hemofilter and a PAN membrane hemofilter in the treatment of a patient with septic acute renal failure. Transfus Apher Sci 40: 49-53, 2009 21) Joannes-Boyau O, Honoré PM, Perez P, et al: High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med 39: 1535-46, 2013 22) Dellinger RP, Levy MM, Rhodes A, et al: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41: 580-637, 2013 23) Sepsis Registry 20: 124-73, 2013 24) / CHDF 22: 85-116, 2011 25) Hirasawa H, Oda S, Nakamura M, et al: Continuous hemodiafiltration with a cytokine-adsorbing hemofilter for sepsis. Blood Purif 34: 164-70, 2012 26) 34: 815-22, 2014 237