Clinical indications and biological mechanisms of splenic irradiation in autoimmune diseases
Clinical indications and biological mechanisms of splenic irradiation in autoimmune diseases
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DOI：
10.1007/pl00002384
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发表时间：
2001-02-01
影响因子：
3.1
通讯作者：
Bamberg, M
中科院分区：
文献类型：
--
作者：
Weinmann, M;Becker, G;Bamberg, M
背景：针对自身免疫性血小板减少症(AIT)或自身免疫性溶血性贫血(AIHA)等自身免疫性疾病，脾照射(SI)是一种尚不为人所知的治疗方法，可为部分患者提供有效、低毒、低成本的治疗方法。患者、材料与方法：本文通过对71例自身免疫性血小板减少症脾照射治疗的研究和一些初步报道的分析，总结了脾照射治疗自身免疫性溶血性贫血的有限经验。所有患者中有10%至20%的患者有持续反应。脾照射对HIV相关性血小板减少症的疗效可能低于其他形式的自身免疫性血小板减少症，但特别是在这一组免疫抑制药物治疗自身免疫性血小板减少症时暴露出一些问题。在自身免疫性溶血性贫血中，有一些关于脾照射疗效的病例报道。结论：对于HIV患者，对于老年患者或脾切除术后并发症的高危患者，脾照射可能是一种治疗方案。对于脾切除术前对免疫抑制药物无效或不宜应用免疫抑制药物的患者，脾照射作为术前治疗，可能是减少血小板减少患者脾切除术不良反应的一种新的应用前景。进一步分析脾照射的生物学机制可能有助于改进患者选择，优化剂量概念和治疗方案，并将提高对放射治疗作为一种免疫调节治疗方式的理解。
Background: Splenic irradiation (SI) is a fairly unknown treatment modality in autoimmune disorders Like autoimmune thrombocytopenia (AIT) or autoimmune hemolytic anemia (AIHA), which may provide an effective, Low toxic and cost-effective treatment for selected patients.Patients, Materials and Methods: This article reviews the Limited experiences on splenic irradiation in autoimmune thrombocytopenia by analyzing the current studies including 71 patients and some preliminary reports on splenic irradiation in autoimmune hemolytic anemia.Results: In autoimmune thrombocytopenia between 40 and 90% of all patients responded, but most of them relapsed within 4 to 6 months after splenic irradiation. Between 10 and 20% of all patients had a sustained response. The efficacy of splenic irradiation in HIV-associated cases of thrombocytopenia is probably Lower than in other forms of autoimmune thrombocytopenia, but especially in this group immunosuppressive drug treatment of autoimmune thrombocytopenia exposes some problems. In autoimmune hemolytic anemia there are some case reports about efficacy of splenic irradiation. Toxicity of splenic irradiation in both diseases was very moderate.Conclusions: For HIV patients, for elderly patients or patients at high risk for complications following splenectomy splenic irradiation might be a treatment option. Splenic irradiation as preoperative treatment in patients not responding to or not suitable For immunosuppressive drugs prior to splenectomy may be a promising mew application of splenic irradiation to reduce adverse effects of splenectomy in thrombocytopenic patients. A further analysis of the biological mechanisms underlying splenic irradiation may help to improve patient selection, to optimize dose concepts and treatment schedules and will improve understanding of radiotherapy as an immunomodulatory treatment modality.