Ohkubo Atsushi, Okado Tomokazu, Kurashima Naoki, Maeda Takuma, Miyamoto Satoko, Nakamura Ayako, Seshima Hiroshi, Iimori Soichiro, Sohara Eisei, Uchida Shinichi, Rai Tatemitsu
Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.
Ther Apher Dial. 2014 Jun;18(3):231-7. doi: 10.1111/1744-9987.12209.
Plasmapheresis is one of the acute treatment modalities for neurological disorders associated with antibodies against glutamic acid decarboxylase (anti-GAD). However, there is little information about the removal kinetics of anti-GAD by various plasmapheresis modalities. Here, we investigated the removal rate of anti-GAD and fibrinogen (Fib) by immunoadsorption (IA), plasma exchange using a conventional plasma separator (OP-PE), and plasma exchange using a high cut-off selective membrane plasma separator (EC-PE) in two cases of anti-GAD-associated neurological diseases. In case 1, IA and OP-PE were used, and the percent reductions were as follows: anti-GAD: 38.2% and 69.1% and Fib: 67.7% and 68.2%, respectively. In case 2, OP-PE and EC-PE were used, and the percent reductions were as follows: anti-GAD: 65.8% and 48.5% and Fib: 68.5% and 19.8%, respectively. OP-PE could remove anti-GAD more efficiently than IA. Further, EC-PE could maintain coagulation factors such as Fib better than IA and OP-PE. It is important to select the appropriate plasmapheresis modality on the basis of the removal kinetics.
血浆置换是治疗与抗谷氨酸脱羧酶抗体（抗GAD）相关的神经系统疾病的急性治疗方式之一。然而，关于各种血浆置换方式对抗GAD的清除动力学的信息很少。在此，我们研究了在两例抗GAD相关神经系统疾病患者中，免疫吸附（IA）、使用传统血浆分离器的血浆置换（OP-PE）以及使用高截留选择性膜血浆分离器的血浆置换（EC-PE）对抗GAD和纤维蛋白原（Fib）的清除率。在病例1中，使用了IA和OP-PE，降低百分比分别如下：抗GAD：38.2%和69.1%，Fib：67.7%和68.2%。在病例2中，使用了OP-PE和EC-PE，降低百分比分别如下：抗GAD：65.8%和48.5%，Fib：68.5%和19.8%。OP-PE比IA能更有效地清除抗GAD。此外，EC-PE比IA和OP-PE能更好地维持诸如Fib等凝血因子。根据清除动力学选择合适的血浆置换方式很重要。
