Department of Nephrology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China.
Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Int Immunopharmacol. 2024 Oct 25;140:112796. doi: 10.1016/j.intimp.2024.112796. Epub 2024 Aug 2.
To compare the differential impact of recombinant protein A immunoadsorption (PAIA) or therapeutic plasma exchange (TPE) on neurological functional improvement and quality of life in patients afflicted with severe acute neuroimmune diseases, including Guillain-Barré syndrome (GBS), myasthenia gravis (MG), neuromyelitis optica spectrum disorder (NMOSD), and anti-NMDA receptor encephalitis (NMDARE).
The retrospective study included 29 patients with moderate to severe disability (modified Rankin scale, mRS≥3) due to acute neuroimmune diseases at the second Xiangya hospital from January 2021 to January 2023. The clinical efficacy of PAIA and TPE in improving neurological function (ΔmRS≥1) and the difference in favorable functional outcomes (mRS 0-2) at three months were evaluated. The impact of both treatments on patients' health-related quality of life (HRQoL) was assessed using a visual analog scale (EQ-VAS) score ranging from 0 to 100.
The findings revealed that the PAIA group exhibited a significantly higher rate of improvement in modified Rankin scale (mRS) scores (ΔmRS≥1) at the three-month follow-up compared to the TPE group (94.4 % vs. 54.5 %, p = 0.018). However, no statistically significant difference was observed between the two treatment modalities in terms of favorable neurological functional outcomes at the three-month mark. Furthermore, the PAIA group demonstrated a significantly higher EQ-VAS score at 14 days post-treatment compared to the TPE group (60.0 vs. 47.7, p = 0.017).
In the short-term management of severe acute neuroimmune diseases, PAIA may present a greater probability of improving neurological function and facilitating an earlier enhancement of quality of life compared to TPE.
比较重组蛋白 A 免疫吸附（PAIA）和治疗性血浆置换（TPE）对重症急性神经免疫性疾病患者（包括吉兰-巴雷综合征（GBS）、重症肌无力（MG）、视神经脊髓炎谱系障碍（NMOSD）和抗 N-甲基-D-天冬氨酸受体脑炎（NMDARE））神经功能改善和生活质量的影响。
本回顾性研究纳入了 2021 年 1 月至 2023 年 1 月在湘雅二医院因急性神经免疫性疾病导致中度至重度残疾（改良 Rankin 量表，mRS≥3）的 29 例患者。评估了 PAIA 和 TPE 改善神经功能（ΔmRS≥1）的临床疗效和 3 个月时良好功能结局（mRS 0-2）的差异。使用视觉模拟量表（EQ-VAS）评分（范围为 0-100）评估两种治疗方法对患者健康相关生活质量（HRQoL）的影响。
研究结果表明，与 TPE 组相比，PAIA 组在 3 个月随访时改良 Rankin 量表（mRS）评分改善（ΔmRS≥1）的比例明显更高（94.4% vs. 54.5%，p=0.018）。然而，两种治疗方法在 3 个月时的良好神经功能结局方面没有统计学上的显著差异。此外，与 TPE 组相比，PAIA 组在治疗后 14 天的 EQ-VAS 评分明显更高（60.0 分 vs. 47.7 分，p=0.017）。
在重症急性神经免疫性疾病的短期治疗中，与 TPE 相比，PAIA 可能更有可能改善神经功能，并更早地提高生活质量。
