APHERESIS IN THE TREATMENT OF POLYMYOSITIS/DERMATOMYOSITIS

多发性肌炎/皮肌炎(PM/DM)患者的治疗 对类固醇的抗药性是有限的，未经证实，而且往往是有毒的。在……里面 非对照试验，血浆交换和白细胞分离都是 据报道是有益的，然而，尽管广泛使用，它们的功效是 还没有确定。我们进行了一项临床试验，以确定 特发性肌炎患者的血液分离治疗。 39例经活检证实为PM/DM的类固醇耐药患者 随机接受血浆置换(n-13)、白细胞分离术(n=13)或假手术 分离术13例。在一次手术中进行了12次分离手术 一个月的期间。肌肉力量、功能能力和血清水平 在12次分离前后检测肌肉相关酶。 会话。每组3名患者均有明显改善。 肌肉力量或功能。然而，尽管有重大的 维拉帕米治疗后患者血清肌酶水平下降 血浆置换组与假采集组比较(P=0.0004)， 在最终肌肉力量或 三个治疗组之间的功能能力。我们的结论是 本研究中使用的血浆交换和白细胞分离不再 对类固醇患者的治疗比假分离更有效- 耐受性多发性肌炎/皮肌炎。

Therapies for patients with polymyositis/dermatomyositis (PM/DM) who are resistant to steroids are limited, unproven and often toxic. In uncontrolled trials, both plasma exchange and leukapheresis have been reported to be of benefit, yet, despite widespread use, their efficacy is not established. We conducted a clinical trial to determine the value of apheresis in patients with idiopathic myositis. Thirty-nine steroid-resistant patients with biopsy-proven PM/DM were randomized to receive plasma exchange (n-13), leukapheresis (n=13), or sham apheresis (n=13). Twelve apheresis procedures were performed over a one month period. Muscle strength, functional capacity, and serum levels of muscle-associated enzymes were measured before and after the 12 apheresis sessions. Three patients in each group noted significant improvement in either muscle strength or function. However, despite a significant decrease in serum levels of muscle enzymes in the patients treated with plasma exchange compared with those receiving sham apheresis (p=0.0004), there were no significant differences in final muscle strength or functional capacity among the three treatment groups. We conclude that plasma exchange and leukapheresis as used in this study were no more effective than sham apheresis as treatment for patients with steroid- resistant polymyositis/dermatomyositis.