Sakata Yasuhisa, Iwakiri Ryuichi, Amemori Sadahiro, Yamaguchi Kanako, Fujise Takehiro, Otani Hibiki, Shimoda Ryo, Tsunada Seiji, Sakata Hiroyuki, Ikeda Yuji, Ando Takashi, Nakafusa Yuji, Fujimoto Kazuma
Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan.
Eur J Gastroenterol Hepatol. 2008 Jul;20(7):629-33. doi: 10.1097/MEG.0b013e3282f5e9a4.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease associated with recurring inflammation of the colorectal mucosa. Recently, cytapheresis has emerged as a new treatment for patients with UC. Removal methods are mainly performed with beads [granulocyte and monocyte/macrophage adsorptive apheresis (GMCAP)] or filters [leukocytapheresis (LCAP)]. Both treatments have been reported to be effective for active UC. There have been few trials, however, comparing the efficacy of GMCAP and LCAP. In this study, we prospectively evaluated the efficacy of LCAP and GMCAP for the treatment of active UC.
Thirty-nine patients [18 male, 21 female; mean age 38.7 years; duration of disease 6 years; clinical activity index (CAI) >6 points] with moderate-to-severe active UC were randomly assigned to the LCAP (n=21) or GMCAP group (n=17). Adacolumn (cellulose acetate beads; Japan Immunoresearch Laboratories, Takasaki, Japan) for GMCAP and Cellsorba EX (polyethylene phthalate fibers; Asahi Medical Co. Ltd, Tokyo, Japan) for LCAP were used for leukocyte removal. Patients received two sessions of cytapheresis in the first week, followed by four weekly administrations. Steroid doses were tapered if patients achieved clinical improvement. When the CAI score had decreased by 5 points or more, the patient was considered to have improved.
Thirteen patients in the GMCAP group and 14 in the LCAP group achieved clinical improvement. No significant difference was found in clinical response and clinical course between LCAP and GMCAP. Hemoglobin levels were significantly decreased immediately after one session of cytapheresis in the LCAP group. No severe adverse effects were observed in any of the patients. No significant differences were observed in any clinical parameters predictive of a response to either LCAP or GMCAP. But in all patients receiving cytapheresis, a high CAI score was a significant risk factor for treatment failure. All of the cytapheresis nonresponders had CAI scores >or=16.
Both GMCAP and LCAP were effective treatments for active UC. Patients with severe UC and a high CAI score were, however, refractory to treatment.
溃疡性结肠炎（UC）是一种慢性炎症性肠病，与结直肠黏膜反复炎症相关。最近，细胞分离术已成为UC患者的一种新治疗方法。去除方法主要通过珠子[粒细胞和单核细胞/巨噬细胞吸附分离术（GMCAP）]或过滤器[白细胞分离术（LCAP）]进行。据报道，这两种治疗方法对活动性UC均有效。然而，比较GMCAP和LCAP疗效的试验很少。在本研究中，我们前瞻性评估了LCAP和GMCAP治疗活动性UC的疗效。
39例中重度活动性UC患者[18例男性，21例女性；平均年龄38.7岁；病程6年；临床活动指数（CAI）>6分]被随机分配至LCAP组（n = 21）或GMCAP组（n = 17）。GMCAP使用Adacolumn（醋酸纤维素珠；日本免疫研究实验室，高崎，日本），LCAP使用Cellsorba EX（聚邻苯二甲酸乙二酯纤维；旭化成医疗株式会社，东京，日本）进行白细胞去除。患者在第一周接受两次细胞分离术治疗，随后每周进行一次，共四次。如果患者临床症状改善，则逐渐减少类固醇剂量。当CAI评分降低5分或更多时，患者被认为有所改善。
GMCAP组13例患者和LCAP组14例患者临床症状改善。LCAP和GMCAP在临床反应和临床病程方面无显著差异。LCAP组在一次细胞分离术后血红蛋白水平立即显著降低。所有患者均未观察到严重不良反应。在预测对LCAP或GMCAP反应的任何临床参数方面均未观察到显著差异。但在所有接受细胞分离术的患者中，高CAI评分是治疗失败的显著危险因素。所有细胞分离术无反应者的CAI评分均≥16分。
GMCAP和LCAP均是治疗活动性UC的有效方法。然而，重度UC且CAI评分高的患者对治疗难治。
