Yeh J H, Chiu H C
Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Shih-Lin, Taipei, Taiwan.
J Neurol. 2000 Jul;247(7):510-3. doi: 10.1007/s004150070149.
Two techniques for plasmapheresis are used in the treatment of myasthenia gravis (MG): immunoadsorption (IA) and double filtration (DF). This controlled study evaluated the differences between these techniques in clinical effects and serological changes. Five patients with generalized MG (clinical states IIb and III) were enrolled; each patient received IA and DF plasmapheresis on separate occasions. Immunosorba TR-350 with an affinity to acetylcholine receptor antibodies (AchRAb) was used for IA, while Evaflux 4A was used as the plasma fractionator for DF. Each course of treatment consisted of five sessions of apheresis. MG score, titers of AchRAb, immunoglobulins (Ig), and plasma biochemistry were assessed by blinded examiners before and immediately after the entire course of treatment. Both treatments effectively ameliorated symptoms of MG. There were no significant changes in MG score between the two groups (IA vs. DF: 2.2 vs. 2.6, P> 0.5). IA had a higher clearance rate of AchRAb than DF (66 % vs. 54 %, P< 0.05), while DF removed more IgA (72% vs. 21%, P< 0.05) and IgM (89% vs. 57%, P< 0.01) than did IA. Although IA removed AchRAb more effectively than DF, the clinical effects between these two treatments were similar. The titers of AchRAb cannot reflect the clinical severity. Some circulating factors other than AchRAb may contribute to the pathogenesis of MG.
血浆置换的两种技术用于治疗重症肌无力（MG）：免疫吸附（IA）和双重过滤（DF）。这项对照研究评估了这些技术在临床效果和血清学变化方面的差异。纳入了5例全身型MG患者（临床状态为IIb和III级）；每位患者分别接受IA和DF血浆置换。对乙酰胆碱受体抗体（AchRAb）具有亲和力的Immunosorba TR - 350用于IA，而Evaflux 4A用作DF的血浆分离器。每个疗程包括5次单采血浆术。在整个疗程之前和之后，由不知情的检查人员评估MG评分、AchRAb滴度、免疫球蛋白（Ig）和血浆生化指标。两种治疗均有效改善了MG症状。两组之间MG评分无显著变化（IA组与DF组：2.2 vs. 2.6，P>0.5）。IA对AchRAb的清除率高于DF（66% vs. 54%，P<0.05），而DF比IA清除更多的IgA（72% vs. 21%，P<0.05）和IgM（89% vs. 57%，P<0.01）。尽管IA比DF更有效地清除AchRAb，但这两种治疗的临床效果相似。AchRAb滴度不能反映临床严重程度。除AchRAb外的一些循环因子可能参与了MG的发病机制。
