Jayne D R
Department of Medicine, Addenbrooke's Hospital, Cambridge, U.K.
Transfus Sci. 1990;11(3-4):263-9. doi: 10.1016/0955-3886(90)90025-E.
The use of plasma exchange in the treatment of systemic vasculitis has been controversial and poorly defined. Since the discovery of anti-neutrophil cytoplasm antibodies (ANCA) and the demonstration of their specificity for systemic vasculitis, there has been a reassessment of the use of plasma exchange along the same lines as its use in anti-glomerular basement membrane disease. ANCA has also contributed to the diagnosis and classification of rapidly progressive glomerulonephritis, in which there is now firmer evidence to support the use of plasma exchange. Current work into the immunoregulation of ANCA by idiotype/anti-idiotype interactions is leading to new approaches to therapy and plasma exchange alone appears capable of inducing prolonged remission in some patients with vasculitis, possibly through an effect on these interactions.
血浆置换在系统性血管炎治疗中的应用一直存在争议且定义不明确。自从发现抗中性粒细胞胞浆抗体（ANCA）并证实其对系统性血管炎的特异性以来，人们开始重新评估血浆置换的应用，其评估方式与在抗肾小球基底膜病中的应用类似。ANCA也有助于快速进展性肾小球肾炎的诊断和分类，目前有更确凿的证据支持在该病中使用血浆置换。目前关于独特型/抗独特型相互作用对ANCA进行免疫调节的研究正在引领新的治疗方法，而且仅血浆置换似乎就能使一些血管炎患者获得长期缓解，这可能是通过对这些相互作用产生影响实现的。
