Plasmapheresis - Technical aspects and indications
Plasmapheresis - Technical aspects and indications
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DOI：
10.1016/s0749-0704(01)00010-0
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发表时间：
2002-04-01
影响因子：
4.3
通讯作者：
Madore, F
中科院分区：
文献类型：
--
作者：
Madore, F
表1总结了血浆置换的一些潜在的有益作用。血浆置换通常用于快速降低自身抗体(如抗肾小球基底膜疾病)或免疫复合体(如狼疮性肾炎)的循环滴度[46]。血浆置换也被认为是一种有效的化疗辅助手段，用于清除多发性骨髓瘤和其他蛋白失调症患者的循环免疫球蛋白或免疫球蛋白成分[51]。其他潜在的适应症包括去除免疫球蛋白以外的成分。血栓因子的去除被认为是血浆置换治疗血栓性血小板减少性紫癜(TTP)的原因[25]。血浆置换也被用于降低其他假定的毒性介质的循环水平，如细菌毒素和炎症介质，用于治疗或治疗败血症和多器官衰竭[48]。输注正常血浆本身可能有有益的效果。事实上，有证据表明，替代有缺陷的血浆成分可能是TTP血浆置换的主要作用机制[7]。其他理论上对免疫功能有益的影响包括消耗补体产物、纤维蛋白原和一些细胞因子，改变独特型/抗独特型抗体平衡，改善网状内皮系统功能[9，29，30]。
Table 1 summarizes some potentially beneficial actions of plasmapheresis. Plasmapheresis is often employed to rapidly lower circulating titers of autoantibodies (e.g., anti-glomerular basement membrane disease) or immune complexes (e.g., lupus nephritis) [46]. Plasmapheresis has also been proposed as a useful adjunct to chemotherapy for removing circulating immunoglobulins or immunoglobulin components in multiple myeloma and other dysproteinemias [5 1]. Other potential indications include the removal of components other than immunoglobulins. The removal of thrombotic factors has been suggested to explain the effect of plasmapheresis in thrombotic thrombocytopenic purpura (TTP) [25]. Plasmapheresis has also been used to decrease circulating levels of other putative toxic mediators such as bacterial toxins and inflammatory mediators in the treatment or sepsis and multiorgan failure [48]. Infusion of normal plasma may itself have beneficial effects. Indeed, there is evidence that replacement of a deficient plasma component may be the principal mechanism of action of plasmapheresis in TTP [7]. Other theoretical beneficial effects on immune function include depletion of complement products, fibrinogen, and some cytokines, alterations in idiotypic/anti-idiotypic antibody balance, and improvement in reticulo-endothelial system function [9,29,30].