Lixelle ameliorates idiopathic thrombocytopenic purpura.
Lixelle ameliorates idiopathic thrombocytopenic purpura.
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Lixelle 可改善特发性血小板减少性紫癜。
DOI：
10.1093/ndt/gfg071
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
Hiromichi Suzuki
中科院分区：
文献类型：
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作者：
Tsuneo Takenaka;Hiromichi Suzuki
先生，我们在这里报告一个有趣的特发性血小板减少性紫癜(ITP)病例。该病例为一名1925年出生的男性患者。他一直很健康，直到1975年表现出上位和蛋白尿。当时，他的血小板计数是0.5310微米。骨髓检查显示造血功能正常，巨核细胞数正常，符合ITP。抗DNA抗体均为阴性。因有出血倾向，未行肾活检。服用类固醇没有任何有益的效果，后来逐渐减少。虽然建议行脾切除术，但患者拒绝接受大手术。尽管接受保守治疗，他还是从1980年开始需要维持性血液透析(每周3天)。开始透析治疗后，血小板计数维持在0.5~1.5310微米之间。患者于1999年接受内窥镜手术治疗腕管综合征。自2000年以来，我们在每个透析中都应用了Lixelle(1.5米)，一种Beta2-微球蛋白吸附柱(Kanegafuchi Chemals，日本东京)，以减缓与透析相关的淀粉样变性的进展[1]。Lixelle是在聚砜透析器(1.6米)之前建立的血统。使用1000U肝素进行透析4h，血液和透析液流量分别维持在200和500毫米明。血小板计数逐渐增加到3-5310微米(图1)。上位率明显下降。2002年，血小板计数为4.2310微米。ITP的发病机制似乎归因于血小板上抗糖蛋白IIb和糖蛋白III的自身抗体的自身反应合成[2]。选择了血小板相关免疫球蛋白(PAIgG)作为探针，因为它能定量ITP的活性[3]。暴露于力克索20分钟后，PAIg G下降32%(从310 nguml降至210nguml)，但总Ig G未下降(从1160 mgudl降至1120mgudl)。信件
Sir, Here we report an interesting case of idiopathic thrombocytopenic purpura (ITP). The case was a male patient born in 1925. He was healthy until he manifested epistasis and proteinuria in 1975. At that time, his platelet count was 0.5310umm. Bone marrow examination revealed normal haematopoiesis with normal megakaryocyte number, consistent with ITP. Anti-DNA antibodies were negative. Renal biopsy was not performed because of bleeding tendency. Steroid was administered without beneficial effects, and tapered later. Although splenectomy was recommended, the patient declined major surgery. Despite conservative treatment, he required maintenance haemodialysis from 1980 (3 daysuweek). Platelet counts were kept low between 0.5 and 1.5310umm after the initiation of dialysis therapy. The patient underwent endoscopic surgery for carpal tunnel syndrome in 1999. Since 2000, we have applied lixelle (1.5 m), a beta2-microglobulin adsorption column (Kanegafuchi Chemicals, Tokyo, Japan), in every dialysis to slow the progression of dialysis-related amyloidosis [1]. Lixelle was set in bloodline prior to the polysulfone dialyser (1.6 m). Dialysis was performed with a total of 1000 U of heparin for 4 h. Blood and dialysate flows were maintained at 200 and 500 mlumin throughout the haemodialysisuhaemoperfusion sessions, respectively. The platelet count gradually increased to 3–5310umm (Figure 1). The frequency of epistasis decreased markedly. In 2002, the platelet count was 4.2310umm. The pathogenesis of ITP appears attributable to autoreactive synthesis of autoantibodies to glycoprotein IIb anduor III on platelets [2]. Platelet-associated IgG (PAIgG) was selected as a probe, because it quantifies the activity of ITP [3]. Exposure to lixelle for 20 min reduced PAIgG by 32% (from 310 to 210 nguml), but not total IgG (from 1160 to 1120 mgudl). Letters