Ramunni Alfonso, De Robertis Francesca, Brescia Paola, Saliani Maria Teresa, Amoruso Michele, Prontera Maria, Dimonte Elena, Trojano Maria, Coratelli Pasquale
Nephrology Section, Department of Internal and Public Medicine, University of Bari, Bari, Italy.
Ther Apher Dial. 2008 Jun;12(3):250-4. doi: 10.1111/j.1744-9987.2008.00575.x.
Plasma exchange has been proposed as support therapy in both acute and chronic forms of multiple sclerosis (MS). For the first time, we aimed to assess whether double filtration plasmapheresis (DFPP) could be clinically efficacious. We describe the case of a patient affected by MS who developed a severe crisis refractory to conventional steroids, and immunosuppressive and immunomodulating therapy. The patient underwent 12 sessions of DFPP. In each session 3000 mL of plasma was treated. Before and immediately after each session the routine laboratory parameters were assessed. Before the apheresis cycle and one month after the end of treatment, encephalic magnetic resonance imaging (MRI) was performed. A neurological examination and assessment of the extended disability status scale (EDSS) were made once each week from the beginning of treatment until one month after the end of the cycle. No therapy was administered during the course of the apheresis cycle, with the exception of a scaled dose of steroids, that was completely withdrawn half-way through the cycle. The immunoglobulin (Ig) G, IgA and IgM values declined from 465 +/- 104 mg/dL, 69 +/- 18 mg/dL, 34 +/- 16 mg/dL, respectively, pre-apheresis to 331 +/- 76 mg/dL, 42 +/- 5 mg/dL, 15 +/- 6 mg/dL, respectively, post-apheresis; C3 and C4 decreased from 105 +/- 27 mg/dL and 21 +/- 5 mg/dL to 75 +/- 9 mg/dL and 15 +/- 4 mg/dL, respectively; fibrinogen went from 228 +/- 72 mg/dL to 128 +/- 28 mg/dL. The EDSS dropped from a value of 6 before the cycle to 5.5 one month after the end of the treatment. As compared with the pretreatment conditions, post-apheresis MRI showed stabilization of the lesions already present, the reduction of one lesion and a complete absence of enhancement of all lesions. DFPP, adopted for the first time in MS, seems to foster a short-term improvement in both the clinical and magnetic resonance images during an acute MS episode.
血浆置换已被提议作为急性和慢性多发性硬化症（MS）的支持性治疗方法。我们首次旨在评估双重过滤血浆置换（DFPP）是否具有临床疗效。我们描述了一名患有MS的患者的病例，该患者出现了对传统类固醇、免疫抑制和免疫调节治疗均无效的严重发作。该患者接受了12次DFPP治疗。每次治疗处理3000毫升血浆。每次治疗前和治疗后立即评估常规实验室参数。在进行血浆分离术周期前和治疗结束后一个月，进行脑磁共振成像（MRI）检查。从治疗开始到周期结束后一个月，每周进行一次神经系统检查并评估扩展残疾状态量表（EDSS）。在血浆分离术周期过程中，除了在周期进行到一半时完全停用的按比例减少剂量的类固醇外，未给予其他治疗。免疫球蛋白（Ig）G、IgA和IgM值分别从血浆分离术前的465±104毫克/分升、69±18毫克/分升、34±16毫克/分升降至血浆分离术后的331±76毫克/分升、42±5毫克/分升、15±6毫克/分升；C3和C4分别从105±27毫克/分升和21±5毫克/分升降至75±9毫克/分升和15±4毫克/分升；纤维蛋白原从228±72毫克/分升降至128±28毫克/分升。EDSS从周期前的6分降至治疗结束后一个月的5.5分。与治疗前情况相比，血浆分离术后MRI显示已存在的病变稳定，一个病变缩小，所有病变均无强化。DFPP首次应用于MS，似乎在急性MS发作期间能促进临床和磁共振图像的短期改善。
