Tesar V, Jelínková E, Jirsa M, Bakosová M, Pitha P, Chábová V
1st Department of Medicine, 1st School of Medicine, Charles University, Prague, Czech Republic.
Blood Purif. 2000;18(2):115-20. doi: 10.1159/000014434.
Plasma exchange (PE) is an effective therapeutic method used in patients with myasthenia gravis (MG) refractory to common therapy and/or with life-threatening respiratory complications. Except for acetylcholine receptor antibodies (AChRAbs), some other inflammatory mediators possibly activated in MG may also be removed during PE. Serum levels of soluble adhesion molecules (sICAM-1 and sVCAM-1), IL-6 and soluble receptors for IL-2 (sIL-2R), IL-6 (sIL-6R) and TNF alpha (sTNF-R II) were measured in 20 MG patients assigned to treatment with PE. On the basis of the serum levels of AChRAb the patients were subdivided into 2 groups (8 patients with low AChRAb, 12 patients with high AChRAb). Soluble adhesion molecules and cytokines were measured before the first and last PE, at the end of the first PE and in the samples of plasma filtrate obtained during the first PE. Before the first PE patients with MG had higher serum levels of sICAM-1, sVCAM-1, sIL-2R and sTNF-R II than controls. Both after the first PE and during the course of PE, a substantial decrease in serum levels of AChRAb, sICAM-1 and sVCAM-1 was recorded. However, serum levels of sIL-2R and sTNF-R II were not significantly influenced by either a single treatment or during the course of PE. There were high levels of AChRAb, soluble adhesion molecules and soluble cytokine receptors in plasma filtrates too. Patients with high circulating AChRAb had higher serum levels of sICAM-1 and sVCAM-1 than patients with low AChRAb. Increased serum levels of soluble adhesion molecules and soluble cytokine receptors in patients with MG suggest some systemic activation of the immune response which is more pronounced in patients with high circulating AChRAb. PE led to the decrease in serum AChRAb and soluble adhesion molecules due to their effective filtration but, on the other hand, serum levels of soluble cytokine receptors were not influenced by PE, in spite of their effective filtration which is probably counteracted by their increased production, possibly stimulated by the contact of the blood with the synthetic membrane.
血浆置换（PE）是一种用于治疗对常规治疗无效和/或伴有危及生命的呼吸并发症的重症肌无力（MG）患者的有效治疗方法。除乙酰胆碱受体抗体（AChRAbs）外，MG中可能被激活的一些其他炎症介质在血浆置换过程中也可能被清除。对20例接受血浆置换治疗的MG患者测定了血清可溶性黏附分子（sICAM-1和sVCAM-1）、白细胞介素-6（IL-6）以及白细胞介素-2（IL-2）、IL-6（sIL-6R）和肿瘤坏死因子α（TNFα）的可溶性受体（sTNF-R II）的水平。根据AChRAb的血清水平将患者分为2组（8例AChRAb水平低的患者，12例AChRAb水平高的患者）。在第一次和最后一次血浆置换前、第一次血浆置换结束时以及第一次血浆置换过程中获得的血浆滤过液样本中测定可溶性黏附分子和细胞因子。在第一次血浆置换前，MG患者的血清sICAM-1、sVCAM-1、sIL-2R和sTNF-R II水平高于对照组。在第一次血浆置换后以及血浆置换过程中，均记录到AChRAb、sICAM-1和sVCAM-1的血清水平大幅下降。然而，sIL-2R和sTNF-R II的血清水平在单次治疗或血浆置换过程中均未受到显著影响。血浆滤过液中也存在高水平的AChRAb、可溶性黏附分子和可溶性细胞因子受体。循环AChRAb水平高的患者的血清sICAM-1和sVCAM-1水平高于AChRAb水平低的患者。MG患者血清可溶性黏附分子和可溶性细胞因子受体水平升高表明免疫反应存在一些全身性激活，在循环AChRAb水平高的患者中更为明显。血浆置换由于其有效的滤过作用导致血清AChRAb和可溶性黏附分子水平降低，但另一方面，可溶性细胞因子受体的血清水平不受血浆置换影响，尽管其有效滤过，这可能被其产量增加所抵消，可能受到血液与合成膜接触的刺激。
