6)膠原病におけるアフェーシス療法(〈シンポジウム〉各科領域におけるアフェレシス療法

概要

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Plasma exchange (PEX) has been tried therapeutically in collagen vascular diseases (CVD), mainly in systemic lupus erythematosus (SLE) in the 1970's and 1980's. However, questions remain concerning its efficacy because it was usually used in combination with other intensive therapies and sham apheresis was difficult to perform. We have experienced several patients who underwent PEX and had favorable outcomes. A 15 year old male SLE patient with severe serological activities (anti-double-stranded DNA antibodies over 300IU/ml, CH50 under 14U/ml) did not respond to methyl-prednisolone (mPSL) pulse therapy with heparin, and his renal function deteriorated (BUN 72mg/dl, Cr 2.5mg/dl). Renal biopsy revealed severe crescentic glomerulonephritis (WHO IV). After PEX, his renal function recovered with follow up mPSL pulse therapy and oral PSL (BUN 17mg/dl, Cr 1.2mg/dl). PEX may also have been effective in a 30 year old female steroid-and immunosuppressants-resistant lupus cystitis patient. PEX was very effective for progressive arthritis and mononeuritis multiplex in a 69 year old malignant rheumatoid arthritis (MRA) patient, but several other MRA patients died in spite of the combination of PEX with other intensive therapies. In severe CVD patients whose humoral immune response seems to play an important role for disease activity, PEX should be performed.
新潟大学の論文