Funauchi M, Ikoma S, Imada A, Kanamaru A
Third Department of Internal Medicine, Kinki University School of Medicine, Osaka, Japan.
J Clin Lab Immunol. 1997;49(2):47-57.
Therapeutic protocol and indication of immunoadsorption therapy (IA) for lupus nephritis (LN) have not been established, although it has been reported to be effective in resistant cases. Here, we performed IA and double filtration plasmapheresis (DFPP) in combination with high-dose methyprednisolone in patients with LN, and studied possible indications of IA.
IA and DFPP were performed in 9 patients each with LN. They were immediately followed by intravenous infusion of 500 mg of methylprednisolone for prevention of rebound phenomenon. After these treatments 1-2 times a week, a total of 4-6 times, clinical findings were observed for 6 months.
The effects on clinical findings such as erythema, fever and arthralgia, serum complement activity, mean urinary protein and reduction of dose of adrenocorticosteroids were comparable in both treatments. Serum titers of ADNA decreased by IA more than DFPP (16% in IA, 38% in DFPP in 3 months), while serum immunoglobulins decreased by IA less than DFPP. Responses in urinary protein after IA tended to be better in patients with high titer of serum ADNA and without nephrotic syndrome, and not associated with disease activity of SLE.
Removal of ADNA was more selective in IA than in DFPP, and the effects of IA were comparable with those of DFPP. Since patients with low titers of serum ADNA and nephrotic syndrome showed poor responses to IA, it might be worth trying rather in patients with early phase of lupus nephritis.
尽管有报道称免疫吸附疗法（IA）对狼疮性肾炎（LN）的难治性病例有效，但该疗法的治疗方案和适应证尚未确立。在此，我们对LN患者联合应用IA、双重滤过血浆置换（DFPP）及大剂量甲泼尼龙，并研究IA可能的适应证。
对9例LN患者分别进行IA和DFPP治疗。治疗后立即静脉输注500mg甲泼尼龙以预防反跳现象。每周进行1 - 2次上述治疗，共进行4 - 6次，观察6个月的临床症状。
两种治疗方法对红斑、发热、关节痛等临床症状、血清补体活性、平均尿蛋白及肾上腺皮质激素剂量减少的影响相当。IA治疗后抗双链DNA（ADNA）血清滴度下降幅度大于DFPP（3个月时IA为16%，DFPP为38%），而IA治疗后血清免疫球蛋白下降幅度小于DFPP。血清ADNA滴度高且无肾病综合征的患者IA治疗后尿蛋白反应倾向于更好，且与系统性红斑狼疮（SLE）疾病活动无关。
IA对ADNA的清除比DFPP更具选择性，IA的效果与DFPP相当。由于血清ADNA滴度低和肾病综合征患者对IA反应较差，IA可能更值得在狼疮性肾炎早期患者中尝试。
