Sawada K, Ohnishi K, Kosaka T, Chikano S, Egashira A, Okui M, Shintani S, Wada M, Nakasho K, Shimoyama T
Fourth Department of Internal Medicine, Hyogo College of Medicine, Japan.
J Gastroenterol. 1997 Oct;32(5):689-95. doi: 10.1007/BF02934123.
A 58-year-old man with subacute fulminant onset of autoimmune hepatitis (AIH) was treated by leukocytapheresis (LCAP) and bilirubin adsorption therapy (BAT), rather than by administration of high-dose corticosteroids as he had mild glucose intolerance, and a definitive diagnosis of AIH was not obtained on admission; further, there was a risk of viral infection. After initiation of the therapies, serum transaminases and bilirubin, immunoglobulins, anti-nuclear antibodies, and rheumatoid factor decreased rapidly, as did the initially high levels of activated cells and several pro-inflammatory cytokines. Liver inflammation observed on liver biopsy settled during the course of the therapies, with no adverse side effects. A pause in the therapies was associated with deterioration; however, restoration of apheresis was followed by normalization. Remission was sustained throughout the period monitored, except for a recurrence 14 months after discharge, which was successfully resolved by two additional LCAP sessions. These results suggest that LCAP influences the causal mechanism(s) of exacerbation of AIH.
一名58岁男性，亚急性暴发性自身免疫性肝炎（AIH）起病，因轻度糖耐量异常未采用大剂量皮质类固醇治疗，而是接受了白细胞去除术（LCAP）和胆红素吸附疗法（BAT）。入院时未确诊AIH，此外还存在病毒感染风险。治疗开始后，血清转氨酶、胆红素、免疫球蛋白、抗核抗体和类风湿因子迅速下降，最初高水平的活化细胞和几种促炎细胞因子也有所下降。肝活检观察到的肝脏炎症在治疗过程中得到缓解，且无不良副作用。治疗暂停与病情恶化相关；然而，恢复血液成分分离术后病情恢复正常。在整个监测期内病情持续缓解，除出院后14个月复发一次，通过额外两次LCAP治疗成功解决。这些结果表明，LCAP影响AIH病情加重的因果机制。
