Therapeutic apheresis in myasthenia gravis.
Therapeutic apheresis in myasthenia gravis.
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DOI：
10.1046/j.1526-0968.2000.004004275.x
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发表时间：
2000-08-01
期刊：
影响因子：
--
通讯作者：
Tonali, P
中科院分区：
文献类型：
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作者：
Batocchi, A P;Evoli, A;Tonali, P
血浆置换（PE）是一种易于应用的快速和大量清除抗体的技术，其在重症肌无力（MG）（一种抗体介导的神经肌肉接头疾病）的治疗中的有益作用已得到充分证实。PE在重症肌无力危象、胸腺切除术前最严重的MG、术后早期以及在逐渐减量或开始免疫抑制治疗期间症状恶化的情况下是有用的。临床疗效从55%到100%不等，改善很少持续超过4-10周;因此必须联合免疫抑制治疗。新的单采技术（双重过滤血浆置换，免疫吸附系统与葡萄球菌蛋白A柱或色氨酸-聚乙烯醇凝胶柱），允许选择性去除IgG和抗AChR抗体最近被用于MG的管理与积极的影响。它们的治疗效果和成本效果是否比PE更有利，仍需证明。
Plasma exchange (PE) is an easily applicable technique for rapid and massive removal of antibodies, and its beneficial role is well established in the management of myasthenia gravis (MG), an antibody-mediated disorder of the neuromuscular junction. PE is useful in myasthenic crisis, in most severe forms of MG before thymectomy, in the early postoperative period, and in cases of symptom worsening during tapering or initiation of immunosuppressive therapy. Clinical efficacy varies from 55% to 100%, and improvement rarely persists for more than 4-10 weeks; thus immunosuppressive therapy has to be associated. New apheretic techniques (double filtration plasmapheresis, immunoadsorption systems with staphylococcal protein A columns or thryptophan-polyvinyl alcohol gel columns) that allow the selective removal of IgG and anti-AChR antibody were recently used in the management of MG with positive effects. Whether their therapeutic effect and cost effect prove more favorable than those obtained by PE still must be demonstrated.