Ohkubo Atsushi, Okado Tomokazu, Sakurasawa Takatoshi, Maeda Takuma, Itagaki Ayako, Yamamoto Hiroko, Miyamoto Satoko, Seshima Hiroshi, Kurashima Naoki, Mori Takayasu, Iimori Soichiro, Sohara Eisei, Rai Tatemitsu, Uchida Shinichi, Naito Shotaro
Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Ther Apher Dial. 2019 Jun;23(3):271-278. doi: 10.1111/1744-9987.12820. Epub 2019 May 29.
Autoimmune neurological diseases are often treated by immunoadsorption using a conventional plasma separator and tryptophan-immobilized column (IA). However, there is only one case report on treatment with immunoadsorption using a selective plasma separator and tryptophan-immobilized column (SeIA) in clinical practice. This study aimed to investigate the removal characteristics of antibodies against acetylcholine receptors (AChRAb), immunoglobulin G, fibrinogen, and factor XIII (FXIII) in IA and SeIA in four patients with myasthenia gravis. A total of 19 sessions of immunoadsorption were performed (five sessions of IA and 14 sessions of SeIA) when the processed plasma volume was 2 L. The corresponding reductions were 52.5% ± 6.2% for AChRAb, 58.8% ± 4.2% for fibrinogen, and 36.9% ± 5.5% for FXIII after one session of IA. The corresponding reductions were 45.2% ± 9.9% for AChRAb, 3.5% ± 6.9% for fibrinogen, and -4.6% ± 11.1% for FXIII after one session of SeIA. The removal rates for AChRAb, fibrinogen, and FXIII in IA were significantly higher than those in SeIA. IA could effectively remove AChRAb, and SeIA could retain fibrinogen and FXIII. IA can be combined with SeIA, resulting in both IgG autoantibodies removal by IA and retention of coagulation factors by SeIA.
自身免疫性神经疾病通常采用传统血浆分离器和色氨酸固定柱免疫吸附法（IA）进行治疗。然而，在临床实践中，关于使用选择性血浆分离器和色氨酸固定柱免疫吸附法（SeIA）治疗的病例报告仅有一例。本研究旨在调查4例重症肌无力患者IA和SeIA对乙酰胆碱受体抗体（AChRAb）、免疫球蛋白G、纤维蛋白原和因子XIII（FXIII）的清除特性。当处理血浆量为2L时，共进行了19次免疫吸附治疗（5次IA和14次SeIA）。IA治疗1次后，AChRAb、纤维蛋白原和FXIII的相应降低率分别为52.5%±6.2%、58.8%±4.2%和36.9%±5.5%。SeIA治疗1次后，AChRAb、纤维蛋白原和FXIII的相应降低率分别为45.2%±9.9%、3.5%±6.9%和-4.6%±11.1%。IA对AChRAb、纤维蛋白原和FXIII的清除率显著高于SeIA。IA能有效清除AChRAb，而SeIA能保留纤维蛋白原和FXIII。IA可与SeIA联合使用，IA可清除IgG自身抗体，SeIA可保留凝血因子。
