吸附性粒细胞和单核细胞单采术对同时使用和未同时使用泼尼松龙的溃疡性结肠炎患者均有效。
Adsorptive Granulocyte and Monocyte Apheresis Is Effective in Ulcerative Colitis Patients Both with and without Concomitant Prednisolone.
作者信息
Matsuda Keiji, Ohno Kohei, Okada Yuka, Yagi Takahiro, Tsukamoto Mitsuo, Fukushima Yoshihisa, Horiuchi Atsushi, Shimada Ryu, Ozawa Tsuyoshi, Hayama Tamuro, Tsuchiya Takeshi, Tamura Junko, Iinuma Hisae, Nozawa Keijiro, Aoyagi Hitoshi, Isono Akari, Abe Koichiro, Kodashima Shinya, Yamamoto Takatsugu, Kawasaki Yoshitaka, Tamura Yoshifuru, Sasajima Yuko, Kondo Fukuo, Hashiguchi Yojiro
机构信息
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
IBD Center, Teikyo University School of Medicine, Tokyo, Japan.
出版信息
Inflamm Intest Dis. 2020 Feb;5(1):36-41. doi: 10.1159/000505484. Epub 2020 Jan 28.
BACKGROUND
The number of ulcerative colitis (UC) patients is increasing in Japan and other countries. Selective depletion of myeloid lineage leucocytes by adsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn (JIMRO, Takasaki, Japan) was introduced as a nonpharmacologic treatment strategy in UC patients in 2000. GMA has been reported to be effective in clinical trials; however, the effect of concomitant prednisolone (PSL) on GMA needs to be clarified.
METHODS
Thirty-nine patients with active UC were treated with GMA at our institute between June 2009 and September 2018. All patients received GMA therapy once or twice a week with the Adacolumn. Conventional medication was to be continued during the whole GMA treatment course. The clinical response was retrospectively evaluated.
RESULTS
According to the partial Mayo score, remission was 33.3%, significant efficacy 25.6%, effective 25.6%, and no response 15.4%. The average partial Mayo score was 6.2 ± 1.4 at entry and significantly declined to 1.8 ± 1.8 after GMA sessions ( < 0.0001). The average number of bowel movements was 9.5 ± 5.6 at entry and significantly declined to 3.0 ± 2.8 after GMA sessions ( < 0.0001). In a comparison between the group treated with concomitant PSL and the group without PSL, the change in partial Mayo score or the number of bowel movements from entry to after GMA sessions was not significantly different. Among 24 patients treated by GMA with concomitant PSL, 75% (18/24) became steroid free.
CONCLUSIONS
The effect of GMA with concomitant PSL and that of GMA without PSL were not different, and GMA was effective irrespective of PSL administration. The present study showed that GMA had efficacy and led many UC patients treated by PSL to be steroid free with no safety concern in the real world, although there is the possibility of recruitment bias due to the retrospective nature of the study.
背景
在日本及其他国家，溃疡性结肠炎（UC）患者数量正在增加。2000年，一种采用吸附柱（日本高崎JIMRO公司生产）进行吸附性粒细胞和单核细胞单采术（GMA）选择性清除髓系白细胞的方法被引入作为UC患者的一种非药物治疗策略。GMA在临床试验中已被报道有效；然而，同时使用泼尼松龙（PSL）对GMA疗效的影响尚需阐明。
方法
2009年6月至2018年9月，我院对39例活动期UC患者采用GMA治疗。所有患者每周接受一次或两次使用吸附柱的GMA治疗。在整个GMA治疗过程中持续使用常规药物。对临床反应进行回顾性评估。
结果
根据部分Mayo评分，缓解率为33.3%，显效率为25.6%，有效率为25.6%，无反应率为15.4%。入组时平均部分Mayo评分为6.2±1.4，GMA治疗后显著降至1.8±1.8（<0.0001）。入组时平均排便次数为9.5±5.6，GMA治疗后显著降至3.0±2.8（<0.0001）。在同时使用PSL的治疗组和未使用PSL的治疗组之间，从入组到GMA治疗后的部分Mayo评分变化或排便次数变化无显著差异。在24例同时使用PSL接受GMA治疗的患者中，75%（18/24）实现了停用类固醇。
结论
同时使用PSL的GMA疗效与未使用PSL的GMA疗效无差异，且无论是否使用PSL，GMA均有效。本研究表明，GMA具有疗效，并且在现实世界中使许多接受PSL治疗的UC患者停用了类固醇且无安全问题，尽管由于研究的回顾性性质存在招募偏倚的可能性。
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