Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis
Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis
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DOI：
10.1016/j.dld.2004.08.004
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发表时间：
2004-12-01
影响因子：
4.5
通讯作者：
Terano, A
中科院分区：
文献类型：
--
作者：
Kanke, K;Nakano, M;Terano, A
背景最近的证据表明，外周血粒细胞和单核细胞/巨噬细胞在溃疡性结肠炎的恶化中起主要作用。我们的目的是研究Adacolumn选择性粒细胞和单核细胞吸附单采术是否能促进活动性溃疡性结肠炎的缓解并节省皮质类固醇。60例活动期溃疡性结肠炎患者，其中39例为复发缓解型溃疡性结肠炎，15例为慢性持续型溃疡性结肠炎，6例为首次发病。粒细胞分离术使用填充有醋酸纤维素珠作为分离载体的Adacolums进行，该载体吸附FcgammaR和携带补体受体的白细胞（粒细胞、单核细胞和一小部分淋巴细胞）。患者在12周内接受了多达10次Adacolumn治疗，每次治疗时间为60-90分钟，流速为30 mL/min。未给予额外药物。用Seo活性指数（AI）评估功效[Seo M，Okada M，Yao T.溃疡性结肠炎患者的疾病活动指数。Am J Gastroenterol 1992;87：971-6]。平均AI为197.5，范围为154.4-277.7。AI < 150为临床显著改善，AI < 100为临床缓解。60例患者中，50例（83.3%）好转，14例缓解，粒细胞置换术对激素依赖患者最有效。入组时，泼尼松龙的平均剂量为每例患者15.3 mg/天，10次治疗后降至3.6 mg/天。粒细胞分离术耐受性良好，无严重不良反应。根据我们在不同溃疡性结肠炎疾病表达和长期暴露于常规药物治疗的患者中的经验，我们认为粒细胞分离术是常规药物治疗的有效辅助手段，可促进活动性溃疡性结肠炎患者的缓解并节省类固醇。(C)2004年意大利胃肠病学编辑由爱思唯尔有限公司出版。保留所有权利。
Background. Recent evidence suggests that peripheral blood granulocytes and monocytes/macrophages have a major role in the exacerbation of ulcerative colitis.Aims. Our objective was to investigate if selective granulocyte and monocyte adsorptive apheresis with Adacolumn promotes remission of active ulcerative colitis and spares corticosteroid.Subjects. Sixty patients with active ulcerative colitis were studied, of whom 39 had relapsing-remitting ulcerative colitis, 15 had chronic continuous and 6 had their first episode of ulcerative colitis.Methods. Granulocytapheresis was done with an Adacolumn filled with cellulose acetate beads as apheresis carriers that adsorb FcgammaR and complement receptors bearing leucocytes (granulocytes, monocytes and a small fraction of lymphocytes). Patients received up to 10 Adacolumn sessions over 12 weeks, one session was 60-90 min at 30 mL/min. No additional medication was given. Efficacy was assessed with Seo's activity index (AI) [Seo M, Okada M, Yao T. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol 1992;87:971-6]. The mean AI was 197.5 and range 154.4-277.7. AI < 150 was considered significant improvement and AI < 100 was considered clinical remission.Results. Of 60 patients, 50 (83.3%) improved, 14 achieved remission, granulocytapheresis was most effective in steroid-dependent patients. At entry, the mean dose of prednisolone was 15.3 mg/day per patient and was reduced to 3.6 mg/day after 10 sessions. Granulocytapheresis was well tolerated and no serious side-effects were observed.Conclusion. Based on our experience in patients with diverse ulcerative colitis disease expression and long-term exposure to conventional drug therapy, we believe that granulocytapheresis is an effective adjunct to conventional medication for promoting remission and sparing steroids in patients with active ulcerative colitis. (C) 2004 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.