アフェレシス施行時における頭部および下肢組織血流量の検討 : 無侵襲連続モニタ法(NICOMM)による臨床評価(<特集>アフェレシス療法における技術的進歩 : 最近のトピックスから)

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Plasmapheresis such as DFPP (double filtration plasmapheresis) and LDL-apheresis (LDL-A) is established as an effective treatment for various autoimmune diseases and familial hypercholesterolemia. In addition, a skin temperature rise in the lower limbs is confirmed during apheresis treatment, and evaluated by thermography and a deep temperature measurement. At a result, for the purpose of improvement of the peripheral circulatory disorder, apheresis therapy is also performed against ASO (arteriosclerosis obliterans) and PAD (peripheral arterial disease) cases. Furthermore, there are some reports which suggest the increasing of head blood flow, but a conventional report examined the issue by using a surface skin thermometer, a plethysmography or a brain perfusion scintigraphy before and after treatment, and there is no direct evaluation of tissue blood flow. In recent years, NICOMM (non-invasive continuous monitoring method) has been developed, which can monitor both head and lower limb tissue blood flow continually and non-invasively with a LDF (laser Doppler flowmeter) at the same time, and a change of tissue blood flow and mean arterial blood pressure (MABP) has been reported mainly on dialysis. We examined the changes of head blood flow (HBF) and lower limb tissue blood flow (LBF) during LDL-A treatment for ASO or PAD cases with NICOMM this time. As a result, it became clear that LBF increased significantly after the treatment. On the other hand, HBF also increased after the treatment, but it was not obvious in comparison with LBF changes. In addition, MABP changed with uniformity. As for us, it is clarified that HBF is maintained to uniformity for various changes of MABP by the examination of a normal case without extracorporeal circulation, and also we report that LBF changes in accordance with a change of MABP. We observed a meaningful increase of HBF and LBF this time whereas MABP was approximately constant. Increase of tissue blood flow was hypothesized in LDL-A from this by a fall of blood viscosity and a reduction of vascular resistance, because of the removal of such a large molecular weight material and/or fibrinogen. For the consideration of mechanisms and treatment effects, NICOMM will be a useful monitoring system. Further examination is needed to improve LDF probes and software for stable recording and actual clinical use.
2006-05-31

アフェレシス施行時における頭部および下肢組織血流量の検討 : 無侵襲連続モニタ法(NICOMM)による臨床評価(<特集>アフェレシス療法における技術的進歩 : 最近のトピックスから)

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