Ito Ayumi, Murasugi Shun, Yonezawa Maria, Omori Teppei, Nakamura Shinichi, Tokushige Katsutoshi
Department of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
J Clin Apher. 2024 Feb;39(1):e22099. doi: 10.1002/jca.22099. Epub 2023 Nov 21.
Primary sclerosing cholangitis has a poor prognosis and can be accompanied by ulcerative colitis. Infection control is essential, so immunosuppressive drugs should ideally be preferably. Granulocyte and monocyte adsorptive apheresis does not suppress the immune system and is used to treat ulcerative colitis. Therefore, this study investigated the efficacy and safety of granulocyte and monocyte adsorptive apheresis in patients with primary sclerosing cholangitis and ulcerative colitis.
We retrospectively evaluated data from patients with primary sclerosing cholangitis with ulcerative colitis who visited our hospital from April 2000 to December 2022 and underwent granulocyte and monocyte adsorptive apheresis (n = 10, number of treatment cycles = 15). Study endpoints were remission induction rate and safety, assessed as changes in liver functions and adverse events.
Seven of the 10 patients were male. The median (min-max) age was 23 (18-77) years. The most common disease type was right-dominant pancolitis. Remission occurred after 86.6% of cycles (13/15). Serum alkaline phosphatase and Aspartate transaminase were significantly lower after treatment (P = .0124, P = .002), and no negative effects on liver function were seen. The only adverse events were headache (n = 1) and decreased blood pressure (n = 1).
Granulocyte and monocyte adsorptive apheresis has high efficacy for intestinal lesions and improves alkaline phosphatase and aspartate transaminase levels (high levels are a poor prognosis factor). It appears to be a treatment option in patients with primary sclerosing cholangitis associated with ulcerative colitis.
原发性硬化性胆管炎预后较差，可伴有溃疡性结肠炎。控制感染至关重要，因此理想情况下应优先选用免疫抑制药物。粒细胞和单核细胞吸附性血浆置换不抑制免疫系统，用于治疗溃疡性结肠炎。因此，本研究调查了粒细胞和单核细胞吸附性血浆置换对原发性硬化性胆管炎合并溃疡性结肠炎患者的疗效和安全性。
我们回顾性评估了2000年4月至2022年12月期间来我院就诊并接受粒细胞和单核细胞吸附性血浆置换的原发性硬化性胆管炎合并溃疡性结肠炎患者的数据（n = 10，治疗周期数 = 15）。研究终点为缓解诱导率和安全性，通过肝功能变化和不良事件进行评估。
10例患者中有7例为男性。中位（最小 - 最大）年龄为23（18 - 77）岁。最常见的疾病类型是右半结肠全结肠炎。86.6%的治疗周期（13/15）后出现缓解。治疗后血清碱性磷酸酶和天冬氨酸转氨酶显著降低（P = .0124，P = .002），且未观察到对肝功能的负面影响。仅出现头痛（n = 1）和血压下降（n = 1）这两种不良事件。
粒细胞和单核细胞吸附性血浆置换对肠道病变有较高疗效，并可改善碱性磷酸酶和天冬氨酸转氨酶水平（高水平是预后不良因素）。它似乎是原发性硬化性胆管炎合并溃疡性结肠炎患者的一种治疗选择。
