重症心不全に対する免疫吸着療法 : 酸化ストレスとの関連を含めた検討(<特集>心疾患とアフェレシス)

概要

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Several groups have reported that the elimination of autoantibodies by immunoadsorption (IA) therapy can lead to short- and long-term improvements in cardiac function of the patients with dilated cardiomyopathy (DCM). We studied 7 patients with DCM. Autoantibodies were removed with IA by passing patients' plasma over tryptophan columns. The level of diacron-reactive oxygen metabolite (d-ROM) was determined as a marker of oxidative stress. Titers of anti-β1-AR autoantibody were decreased significantly from 27.8±5.0 to 18.7±5.5U/ml by this treatment. IA increased cardiac index from 1.71±0.40 to 1.97±0.41L/min/m^2 and increased LVEF from 22.8±6.1 to 29.1±9.1% (p<0.05). The d-ROM level decreased significantly from 392.7±17.0 to 314.1±22.0 Carratelli units, and was negatively associated with LVEF before and after IA therapy (r=-0.601, p<0.05). The serum TNF-α level also significantly decreased from 1.41±0.81 to 0.17±0.45pg/ml (p<0.01) after IA therapy, and was correlated to the reduction in d-ROM (p<0.05). In conclusion, oxidative stress reduction due to TNF-α may be responsible for the beneficial effect of IA therapy in patients with DCM.
2010-05-31