背景：随着人口老龄化和生活方式的改变，慢性威胁肢体缺血（CLTI）的患者数量正在增加，难治性或复发性病变更为常见，尤其是慢性透析患者。2021年3月，日本医疗保险系统批准了一种新型的硫酸葡聚糖和L-色氨酸固定化纤维素珠柱直接血液灌流（DHP）作为CLTI的治疗方法。
方法：我们回顾性分析了2021年5月至2022年10月在我院使用新型色谱柱（Rheocarna）（DHP-R）进行DHP治疗的17例透析患者的CLTI。DHP-R的短期疗效由足部护理团队根据皮肤颜色的评估每2周定性判断,温暖,溃疡上皮化或溃疡区域收缩，和脚痛。在最后的DHP-R会话之后做出疗效的最终判断。
结果：患者的中位年龄为66岁，中位透析时间为10年,15例（88%）为男性，15例（88%）患有糖尿病。会议总数的中位数为8次。在比较DHP-R有效和无效的组时，包括患者背景数据在内的任何因素都没有显着差异(即，年龄,糖尿病,低密度脂蛋白胆固醇，血红蛋白,透析持续时间,等。),抗凝剂的类型，以及在会话期间出现血压下降或回路凝血的发作。在将抗凝剂从肝素改为甲磺酸Nafamostat（NM）后，三例在会议期间出现有症状的低血压和两例随着肝素剂量的增加而没有改善的回路凝血均立即解决。
结论：需要确定DHP-R有利的患者特征，并需要一些可靠的指标来快速决定继续DHP-R。此外,验证使用NM作为抗凝剂是否会影响DHP-R在CTLI治疗中的疗效仍然是一个需要解决的挑战.
BACKGROUND: With population aging and lifestyle changes, the number of patients with chronic limb-threatening ischemia (CLTI) is increasing, and refractory or recurrent lesions are more common, especially in chronic dialysis patients. In March 2021, a new type of adsorptive cellulose bead column immobilized with dextran sulfate and L-tryptophan for direct hemoperfusion (DHP) was approved by Japan\'s medical insurance system as a treatment for CLTI.
METHODS: We retrospectively analyzed 17 cases of CLTI in dialysis patients treated with DHP using the novel column (Rheocarna) (DHP-R) at our hospital from May 2021 to October 2022. The short-term of efficacy of DHP-R was judged qualitatively by the foot care team every 2 weeks based on the assessment of skin color, warmth, ulcer epithelialization or shrinkage of the ulcer area, and foot pain. The final judgment of efficacy was made after the final DHP-R session.
RESULTS: The median age of patients was 66 years, the median dialysis duration was 10 years, 15 cases (88%) were male, and 15 cases (88%) had diabetes. The median total number of sessions was eight. In comparing the groups in which DHP-R was effective and ineffective, there was no significant difference in any factors including patient background data (i.e., age, diabetes, low-density lipoprotein cholesterol, hemoglobin, dialysis duration, etc.), type of anticoagulants, and presence of episodes of blood pressure drop or circuit clotting during session. Three cases with symptomatic hypotension during the session and two cases with circuit clotting that did not improve with increased heparin dose all resolved immediately after changing the anticoagulant from heparin to nafamostat mesylate (NM).
CONCLUSIONS: Identification of patients\' characteristics in which DHP-R is favorable and some reliable index that allow a rapid decision to continue DHP-R are needed. In addition, validating whether the use of NM as anticoagulant affects the efficacy of DHP-R for CTLI treatment remains a challenge to resolve.
