Tesar V, Jelínková E, Jirsa M, Bakosová N, Pit'ha V, Chábová V
I. interní klinika 1. LF UK a VFN, Praha.
Cas Lek Cesk. 1998 Nov 2;137(21):654-9.
Plasma exchange (PE) is effective therapeutic method used in patients with myasthenia gravis (MG) refractory to common therapy and/or with life-threatening respiratory complications. Except from acetylcholine receptor antibodies (AChRAb) some other inflammatory mediators possibly activated in MG may be also removed during PE.
Serum levels of soluble adhesion molecules (sICAM-1 and sVCAM-1), IL-6 and soluble receptors for IL-2 (sIL-2R), IL6 (sIL-6R) and TNF alpha (sTNF-R II) were measured in 20 patients (pts) with MG indicated to the treatment with PE. Pts were subdivided on the basis of the serum levels of AChRAb into 2 groups (8 pts with low AChRAb, 12 pts with high AChRAb). Soluble adhesion molecules and cytokines were measured before the 1st and last PE, at the end of the 1st PE and in the samples of plasma filtrate obtained during the 1st PE. Pts with MG had before the 1st PE higher serum levels of sICAM-1, sVCAM-1, sIL-2R and sTNF-R II than controls. Both the first PE and the course of PE led to the substantial decrease of serum levels of AChRAb, sICAM-1 and sVCAN-1, serum levels of sIL-2R and sTNF-R II were not, however, significantly influenced by both the single and the course of PE. There were high levels of AChRAb, soluble adhesion molecules and soluble cytokine receptors in plasma filtrate, too. Pts with high circulating AChRAb had higher serum levels of sICAM-1 and sVCAM-1 than pts with low AChRAb.
Increased serum levels of soluble adhesion molecules and soluble cytokine receptors in pts with MG indicated to the treatment by PE suggest some systemic activation of immune response which is more pronounced in pts with high circulating AChRAb. PE led to the decrease of serum AChRAb and soluble adhesion molecules due to their effective filtration, but, on the other hand, serum levels of soluble cytokine receptors were not influenced by PE, in spite of their effective filtration which is probably counteracted by their increased production, possibly stimulated by the contact of the blood with synthetic membrane.
血浆置换（PE）是用于治疗对常规治疗无效和/或伴有危及生命的呼吸并发症的重症肌无力（MG）患者的有效治疗方法。除乙酰胆碱受体抗体（AChRAb）外，MG中可能被激活的一些其他炎症介质在血浆置换过程中也可能被清除。
检测了20例拟接受血浆置换治疗的MG患者血清中可溶性黏附分子（sICAM-1和sVCAM-1）、白细胞介素-6（IL-6）以及白细胞介素-2（IL-2）、白细胞介素-6（IL-6）和肿瘤坏死因子α（TNFα）的可溶性受体（sIL-2R、sIL-6R和sTNF-R II）水平。根据AChRAb血清水平将患者分为2组（8例AChRAb水平低的患者，12例AChRAb水平高的患者）。在第1次和最后1次血浆置换前、第1次血浆置换结束时以及第1次血浆置换过程中获得的血浆滤过液样本中检测可溶性黏附分子和细胞因子。MG患者在第1次血浆置换前血清中sICAM-1、sVCAM-1、sIL-2R和sTNF-R II水平高于对照组。第1次血浆置换及整个血浆置换过程均导致AChRAb、sICAM-1和sVCAN-1血清水平大幅下降，然而，sIL-2R和sTNF-R II血清水平未受单次或整个血浆置换过程的显著影响。血浆滤过液中AChRAb、可溶性黏附分子和可溶性细胞因子受体水平也较高。循环AChRAb水平高的患者血清中sICAM-1和sVCAM-水平高于AChRAb水平低的患者。
拟接受血浆置换治疗的MG患者血清中可溶性黏附分子和可溶性细胞因子受体水平升高提示免疫反应存在一定的全身激活，在循环AChRAb水平高的患者中更为明显。血浆置换因其有效滤过导致血清AChRAb和可溶性黏附分子水平下降，但另一方面，可溶性细胞因子受体血清水平未受血浆置换影响，尽管其有效滤过，但可能因血液与合成膜接触刺激其产生增加而被抵消。
