Sato T, Koga N, Nagano T, Ohteki H, Masuda T, Agishi T
Koga Hospital, Kurume City, Japan.
Int J Artif Organs. 1991 Dec;14(12):800-4.
Lymphocytapheresis using thoracic duct drainage (TDD) is a recognized technique of extracorporeal immunomodulation for various autoimmune diseases such as rheumatoid arthritis (RA), and its clinical benefit has been reported and generally accepted. Lymphocytapheresis using TDD is very selective for removing lymphocytes (especially helper T-cells) but raises some problems such as hypoproteinemia due to the massive removal of lymph, and difficulties in repeated treatment. Along with the development of a new polyester fiber filter, we have developed a simple and effective method of lymphocytapheresis for wide adoption for these techniques. We performed lymphocytapheresis using TDD in patients with RA and previously reported its clinical efficacy indicated by the significantly lower number of peripheral lymphocytes and T4/T8 ratio. We present here our newly-developed on-line system designed to prevent hypoproteinemia. Furthermore we report on the advantages with a new subcutaneous vascular access device set up to manage the problems of repeated treatments. A small reservoir for keeping the thoracic duct open and returning lymph to the patient permitted sufficient lymph drainage and removal of lymphocytes and the clinical application of TDD is discussed.
使用胸导管引流（TDD）的淋巴细胞去除术是一种用于多种自身免疫性疾病（如类风湿性关节炎（RA））的体外免疫调节公认技术，其临床益处已得到报道并被普遍接受。使用TDD的淋巴细胞去除术在去除淋巴细胞（尤其是辅助性T细胞）方面具有高度选择性，但会引发一些问题，如因大量引流淋巴导致的低蛋白血症以及重复治疗的困难。随着新型聚酯纤维滤器的开发，我们已开发出一种简单有效的淋巴细胞去除术方法，以便广泛应用于这些技术。我们对类风湿性关节炎患者采用TDD进行淋巴细胞去除术，并曾报道其临床疗效表现为外周淋巴细胞数量和T4/T8比值显著降低。在此，我们展示我们新开发的旨在预防低蛋白血症的在线系统。此外，我们报告了一种新的皮下血管通路装置的优势，该装置用于解决重复治疗的问题。一个用于保持胸导管开放并将淋巴回流至患者的小型储液器实现了充足的淋巴引流以及淋巴细胞的去除，并对TDD的临床应用进行了讨论。
