Kikuyama Risa, Fukunaga Ken, Kawai Mikio, Yokoyama Yoko, Kamikozuru Koji, Hida Nobuyuki, Ohda Yoshio, Takeda Naohisa, Yoshida Koji, Iimuro Masaki, Kato Kyoichi, Kono Tomoaki, Nogami Koji, Nagase Kazuko, Nakamura Shiro, Takei Yoshiyuki, Miwa Hiroto, Matsumoto Takayuki
Division of Lower Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Ther Apher Dial. 2011 Aug;15(4):360-6. doi: 10.1111/j.1744-9987.2011.00968.x.
Granulocyte/monocyte adsorption (GMA) has been introduced as an adjunct intervention for active ulcerative colitis (UC) patients. The processed blood volume (PV) per GMA session is an important factor for its efficacy because depletion of elevated/activated myeloid leukocytes is its main action. Hitherto, this aspect of GMA has been largely ignored. Thirty-three patients were enrolled for remission induction therapy with five weekly GMA sessions at a standard PV of 1800 mL, regardless of patients' bodyweight (BW). The patients were divided into three groups: high (H)BW (≥ 65 kg, n = 11), 50 kg ≤ medium (M)BW < 65 kg (n = 12), and low (L)BW (≤ 50 kg, n = 10). UC clinical activity index (CAI) was according to Lichtiger, and the clinical efficacies were evaluated at both one week post 3(rd) GMA (Week 4) and one week post 5(th) GMA (Week 6). The average BW was 70.9 ± 6.2 kg in HBW, 55.8 ± 4.5 kg in MBW, and 46.8 ± 1.2 kg in LBW, indicating the mean PV/BW in the three groups being 25.6 ± 2.12, 32.5 ± 2.50, and 38.7 ± 1.0 (mL/kg, P < 0.05), respectively. The LBW group consisted of female patients only. Significant improvements of CAI were seen before treatment at either Week 4 or Week 6 in all groups. A significantly higher remission rate was achieved in the LBW (80.0%) vs. MBW (33.3%) or HBW (27.3%) at Week 6 (P < 0.03). According to this GMA evaluation, the lower-limit of optimum PV/kg should be higher than 38.7 mL/kg for its potential clinical efficacy to be significantly greater than the routine GMA method. Additional BW-oriented GMA studies in larger and gender controlled cohorts of patients should strengthen our findings.
粒细胞/单核细胞吸附术（GMA）已被引入作为活动期溃疡性结肠炎（UC）患者的辅助干预措施。每次GMA治疗的处理血容量（PV）是其疗效的一个重要因素，因为清除升高/活化的髓系白细胞是其主要作用。迄今为止，GMA的这一方面在很大程度上被忽视了。33例患者接受缓解诱导治疗，每周进行5次GMA治疗，标准PV为1800 mL，无论患者体重（BW）如何。患者分为三组：高体重（H）组（≥65 kg，n = 11）、50 kg≤中等体重（M）组<65 kg（n = 12）和低体重（L）组（≤50 kg，n = 10）。UC临床活动指数（CAI）按照Lichtiger标准，在第3次GMA治疗后1周（第4周）和第5次GMA治疗后1周（第6周）评估临床疗效。H组平均体重为70.9±6.2 kg，M组为55.8±4.5 kg，L组为46.8±1.2 kg，表明三组的平均PV/BW分别为25.6±2.12、32.5±2.50和38.7±1.0（mL/kg，P<0.05）。L组仅由女性患者组成。所有组在第4周或第6周治疗前CAI均有显著改善。第6周时，L组（80.0%）的缓解率显著高于M组（33.3%）或H组（27.3%）（P<0.03）。根据这项GMA评估，为使潜在临床疗效显著高于常规GMA方法，最佳PV/kg的下限应高于38.7 mL/kg。在更大规模且性别受控的患者队列中开展以体重为导向的额外GMA研究应能强化我们的研究结果。
