Granulocytapheresis is useful as an alternative therapy in patients with steroid-refractory or -dependent ulcerative colitis
Granulocytapheresis is useful as an alternative therapy in patients with steroid-refractory or -dependent ulcerative colitis
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DOI：
10.1097/00054725-200405000-00012
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发表时间：
2004-05-01
影响因子：
4.9
通讯作者：
Hibi, T
中科院分区：
文献类型：
--
作者：
Naganuma, M;Funakoshi, S;Hibi, T
背景：近年来，粒细胞和单核细胞吸附单采术（GCAP）已被证明是安全和有效的活动性溃疡性结肠炎（UC）。我们分析了GCAP（G-1 Adacolumn）在激素难治性和依赖性UC患者中的安全性和有效性。G-1 Adacolumn填充有选择性吸附粒细胞和单核细胞/巨噬细胞的醋酸纤维素载体。这些患者在4周内接受了5次单采。20例患者患有类固醇难治性UC（组1），10例患者患有类固醇依赖性UC（组2）。结果：44例GCAP治疗的患者中，24例（55%）获得缓解（CAI ≤ 4），9例（20%）出现临床反应，11例（25%）无变化。10例重度激素难治性UC（CAI ≥ 12）患者中仅2例（20%）获得缓解，而10例中度激素难治性UC患者中7例（70%）获得缓解（p < 0.05）。GCAP治疗后，10例类固醇依赖性UC患者中有9例（90%）的皮质类固醇剂量逐渐减少。第3组14例患者中有12例（86%）表现出症状改善，并且可以避免在GCAP后再次使用类固醇。没有严重的不良反应occurrence.Conclusions：这项研究的结果表明，GCAP可能是一个有用的替代治疗中度类固醇难治性或依赖性UC患者，虽然环孢素A或结肠切除术是必要的，在严重的UC患者。GCAP也可能有助于避免复发时再次使用类固醇。需要随机对照临床试验来证实这些发现。
Background: Recently, granulocyte and monocyte adsorption apheresis (GCAP) has been shown to be safe and effective for active ulcerative colitis (UC). We analyzed the safety and efficacy of GCAP (G-1 Adacolumn) in patients with steroid-refractory and -dependent UC. G-1 Adacolumn is filled with cellulose acetate carriers that selectively adsorb granulocytes and monocytes/macrophages.Methods: Forty-four patients with UC were treated with GCAP. These patients received 5 apheresis sessions over 4 weeks. Twenty patients had steroid-refractory UC (group 1) and 10 had steroid-dependent UC (group 2). Fourteen patients who did not want re-administration of steroids were treated with GCAP at the time of relapse, just after discontinuation of steroid therapy (group 3).Results: Of 44 patients treated with GCAP, 24 (55%) obtained remission (CAI less than or equal to 4),9 (20%) showed a clinical response, and 11(25%) remained unchanged. Only 2 of 10 patients (20%) with severe steroid-refractory UC (CAI greater than or equal to 12) achieved remission, whereas 7 of 10 patients (70%) with moderate steroid-refractory UC achieved remission (p < 0.05). The dose of corticosteroids was tapered in 9 of 10 (90%) patients with steroid-dependent UC after GCAP therapy. Twelve (86%) of 14 patients in group 3 showed an improvement in symptoms and could avoid re-administration of steroids after GCAP. No severe adverse effects occurred.Conclusions: The findings of this study suggest that GCAP may be a useful alternative therapy for patients with moderate steroid-refractory or -dependent UC, although cyclosporin A or colectomy is necessary in patients with severe UC. GCAP may also be useful for avoiding re-administration of steroids at the time of relapse. Randomized, controlled clinical trials are needed to confirm these findings.