Adacolumn Granulocyte-Apheresis for Alcoholic Hepatitis: Preliminary Study
Adacolumn Granulocyte-Apheresis for Alcoholic Hepatitis: Preliminary Study
复制标题
DOI：
10.1016/j.transproceed.2015.12.055
复制
发表时间：
2016-03-01
影响因子：
0.9
通讯作者：
Rossi, M.
中科院分区：
文献类型：
--
作者：
Morabito, V.;Novelli, S.;Rossi, M.
导言。酒精性肝炎(AH)是一种影响肝脏的急性-慢性炎症反应。现已认识到白细胞(WBC)参与了AH的发病机制和预后。本研究的目的是使用Adacolumn，它可以选择性地吸附血液中的髓系白细胞(粒细胞和单核/巨噬细胞)，改善患者的临床状况。对6例确诊为急性早幼粒细胞白血病的患者行腺泡巨噬细胞分离术。纳入标准：对皮质类固醇治疗无效的患者，Maddrey判别功能(MDF)和GT；32，MELD评分20-26。患者接受了连续5天的5次1小时的疗程，并在28天进行了随访。色谱柱放置在体外环境中，灌流速度为30毫升/分钟，持续时间为60分钟。在分离治疗周期前后评估肝脏参数、白细胞计数、促炎细胞因子、凝血功能和预测评分。5天后，发现白细胞计数(P<；.014)和细胞因子如白介素6(P<；.019)、肿瘤坏死因子α(TNF；α)(P<；.02)和IL-8(P<；.029)显著改善。结果可能确定了天冬氨酸转氨酶(AST；P<；0.02)和丙氨酸转氨酶(ALT；P<；.011)的降低，尽管我们没有观察到胆红素、凝血酶原时间(PT)和Maddrey评分有显著改善。MELD评分的改善依赖于血浆国际标准化比率的改善，没有考虑到这一点。随访第28天，PT、IL-6、TNF-α、AST、ALT均有明显改善。Adacolum分离是安全的，能够确定炎症标志物减少的患者的临床状况的改善。需要更多的患者来验证这些结果。
Introduction. Alcoholic hepatitis (AH) is an acute-on-chronic inflammatory response affecting the liver. It has been recognized that white blood cells (WBCs) are involved in the pathogenesis and in the prognosis of AH. The aim of study was to use Adacolumn, which can selectively adsorb myeloid linage leucocytes (granulocytes and monocytes/macrophages) from the blood in the column and improve the clinical status of patients.Materials. Six patients with a diagnosis of AH were treated with Adacolumn granulocyteapheresis therapy. Inclusion criteria: patients not responders to corticosteroids therapy with Maddrey Discriminant Function (MDF) >32 and MELD score 20-26. The patients underwent five 1-hour sessions for 5 consecutive days with a follow-up at 28 days. The column was placed in an extracorporeal setting with a perfusion rate of 30 mL/min and a duration of 60 minutes. Liver parameters, WBC count, proinflammatory cytokines, coagulation, and predictive scores were valued before and after the cycle of apheresis treatment.Results. After 5 days, the findings showed a significant improvement of WBC count (P < .014) and cytokines such as interleukin (IL)-6 (P < .019), tumor necrosis factor a (TNF alpha) (P < .02), and IL-8 (P < .029). The results probably determined a reduction of aspartate transaminase (AST; P < .02) and alanine transaminase (ALT; P < .011), although we did not observe a significant improve in bilirubin, prothrombin time (PT), and Maddrey score. The improvement of MELD score, depending on an improvement of international normalized ratio for administration of plasma, was not considered. At day 28 of follow-up, PT, IL-6, TNF alpha, AST and ALT results significantly improved.Conclusions. The Adacolumn apheresis was safe and was able to determine an improvement of clinical status of patients with reduction of inflammatory markers. More patients are needed to validate these results.