Bambauer Rolf, Latza Reinhard, Bambauer Carolin, Burgard Daniel, Schiel Ralf
Institute for Blood Purification, Homburg.
Laboratorium of Medicine, St Ingbert.
Open Access Rheumatol. 2013 Nov 13;5:93-103. doi: 10.2147/OARRR.S34616. eCollection 2013.
Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a bad prognosis without treatment. Therapeutic apheresis in combination with immunosuppressive therapies has led to a steady increase in survival rates over the last 35 years. Here we provide an overview of the most important pathogenic aspects indicating that therapeutic apheresis can be a supportive therapy in some systemic autoimmune diseases, such as systemic lupus erythematosus, antiphospholipid syndrome, rheumatoid arthritis, and inflammatory eye disease. With the introduction of novel and effective biologic agents, therapeutic apheresis is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents, and in patients with renal involvement, acute generalized vasculitis, thrombocytopenia, leucopenia, pulmonary, cardiac, or cerebral involvement. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved considerably in recent years, due in part to very aggressive therapy schemes.
基于免疫发病机制的系统性自身免疫性疾病会产生自身抗体和循环免疫复合物，从而导致各个器官组织发生炎症。在大多数情况下，这些疾病若不治疗，预后较差。在过去35年里，治疗性血液成分单采与免疫抑制疗法相结合使生存率稳步提高。在此，我们概述最重要的致病方面，表明治疗性血液成分单采在某些系统性自身免疫性疾病中可作为一种支持性疗法，如系统性红斑狼疮、抗磷脂综合征、类风湿关节炎和炎症性眼病。随着新型有效生物制剂的引入，治疗性血液成分单采仅适用于严重病例，如尽管接受了免疫抑制疗法和/或生物制剂治疗仍快速进展的病例，以及有肾脏受累、急性全身性血管炎、血小板减少、白细胞减少、肺部、心脏或脑部受累的患者。在自身免疫性疾病的轻度形式中，免疫抑制疗法和/或生物制剂治疗似乎就足够了。近年来，由于部分采用了非常积极的治疗方案，伴有不同器官表现的自身免疫性疾病的预后有了显著改善。
