Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study
Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study
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DOI：
10.1093/ndt/gfn555
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发表时间：
2009-03-01
影响因子：
6.1
通讯作者：
Li Leishi
中科院分区：
文献类型：
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作者：
Zhang Xin;Liu Zhihong;Li Leishi
背景对于脂蛋白肾小球病（LPG）患者，尚无既定的治疗方法。蛋白A免疫吸附已被证明可有效减少肾病综合征患者的蛋白尿。在这项非对照的初步研究中，我们研究了免疫吸附到葡萄球菌蛋白A上作为LPG治疗的效率。13例肾活检证实的LPG患者接受葡萄球菌蛋白A免疫吸附治疗。免疫吸附每疗程10个周期，10个疗程为1个疗程。每个疗程共再生30 L血浆。单次免疫吸附过程导致蛋白尿从4.01 +/- 3.09 g/24 h快速下降至1.21 +/- 0.97 g/24 h（平均值+/- SD）（n = 13，P = 0.001），沿着载脂蛋白E（apo E）从9.79 +/- 5.04 mg/dl急剧下降至6.20 +/- 2.22 mg/dl（P = 0.004）。重复肾活检（n = 12）显示肾小球内脂蛋白血栓几乎消失。6例患者参加了长期结局的研究，蛋白尿在12个月内恢复到基线水平。4例复发患者接受重复免疫吸附治疗;治疗结束时，尿蛋白从5.02 ± 1.85 g/24 h降至1.64 ± 0.55 g/24 h，血清apo E从14.65 ± 11.17 mg/dl降至7.90 ± 1.72 mg/dl。无严重并发症发生。我们的观察结果表明，免疫吸附蛋白A可能是一种有效的治疗，以解决肾小球内血栓和改善肾病综合征的LPG患者。需要进一步的研究来确定免疫吸附对LPG患者长期效应的影响。
Background. No established therapy is available for patients with lipoprotein glomerulopathy (LPG). Protein A immunoadsorption has been proved to be effective in reducing proteinuria in patients with nephrotic syndrome. In this uncontrolled pilot study, we investigated the efficiency of immunoadsorption onto staphylococcal protein A as treatment for LPG.Methods. Thirteen patients with renal biopsy-proven LPG were treated with staphylococcal protein A immunoadsorption. Immunoadsorption was administered for 10 cycles per session and 10 sessions as a course. A total of 30 l of plasma was regenerated in each course.Results. Single immunoadsorption course led to a rapid decline in proteinuria from 4.01 +/- 3.09 g/24 h to 1.21 +/- 0.97 g/24 h (mean +/- SD) (n = 13, P = 0.001), along with a dramatic decline in apolipoprotein E (apo E) from 9.79 +/- 5.04 mg/dl to 6.20 +/- 2.22 mg/dl (P = 0.004). A repeated renal biopsy (n = 12) showed that intraglomerular lipoprotein thrombi almost disappeared. Six patients were enrolled in the investigation of long-term outcome, and proteinuria returned to baseline levels within 12 months. Four recurrent patients received repeat immunoadsorption treatment; proteinuria decreased from 5.02 +/- 1.85 g/24 h to 1.64 +/- 0.55 g/24 h at the end of the treatment, serum apo E decreased from 14.65 +/- 11.17 mg/dl to 7.90 +/- 1.72 mg/dl. No patients suffered from severe complications.Conclusion. Our observations suggest that immunoadsorption onto protein A might be an effective treatment for resolving intraglomerular thrombi and improving nephrotic syndrome in patients with LPG. Further studies are required to define the influence of immunoadsorption on long-term effects in LPG patients.