摘要
目的 :探讨蛋白A免疫吸附治疗肾脏病的临床疗效。 方法 :选择 2 0 0 1年 11月～ 2 0 0 3年 8月在南京总医院住院 36例患者 (系统性红斑狼疮性肾炎 7例 ,抗肾小球基膜抗体疾病 5例 ,肾移植术后急性排斥 10例 ,二次移植 1例 ,脂蛋白肾病 7例 ,膜增殖性肾炎、过敏紫癜性肾炎、冷球蛋白血症、干燥综合征、格林 巴利综合征及药物中毒各 1例 ) ,应用基因重组蛋白A免疫吸附柱进行免疫吸附治疗 2 0 4例次 ,平均每例治疗 5 .6 7例次 ,血浆吸附总量 (6 14 2 3± 112 0 9)L。 结果 :蛋白A免疫吸附柱吸附治疗单次过柱IgG结合率为 (95 1± 4 0 ) % ,IgM为 (38 8± 10 3) % ,IgA为 (2 5 2± 13 7) % ,C3 为 (14 1± 9 4 ) % ,C4(12 1± 0 71) %。患者每次免疫吸附治疗后血浆IgG、IgA、IgM及补体分别下降为 (6 3 1± 16 5 ) %、(2 5 2± 13 7) %、(30 8± 10 3) %及C3 (14 1± 9 4 ) % ,C4(12 1± 10 7) %。 7例系统性红斑狼疮性肾炎 (SLE)患者治疗后病情缓解 ,ANA及ds DNA转阴率 5 0 % ;5例抗肾小球基底膜抗体疾病 ,治疗后 3例血清抗 GBM抗体转阴 ,4个月后仍阴性 ,1例较治疗前下降 6 2 8% ,第二个疗程转阴性 ;4例治疗前已行血液透析 ,其中 1例摆脱血液透析 ,1例肾功能稳定 ;10例肾移植术后急性?
Objective:To observe the clinical application and effect of immunoadsorption in severe pat ients treated by a native protein A-based apparatus. Methodology:Thirty-six patients with various diseases including 7 cases of systemic lupus e rythematosus (SLE), 5 anti-glomerular basement membrane (GBM) disease, 10 acute rejection after renal transplantation, 7 liponephropathy, one case due to high panel reactive antibodies (PRA) level (before receiving a second renal transplan tation), one membranoproliferative glomerulonephritis, one Henoch-Schnlein ne phritis, one cryoglobulinemic glomerulonephristis, one Sjgren's syndrome, one Guillain-Barre's syndrome and one case of drug intoxication were enrolled this study. All of them received immunoadsorption using a native genetic recombinatio n protein A-based apparatus (WCXJQ blood purification apparatus). In total 204 courses of immunoadsorption were performed in 36 cases, and average courses per case were 5.67 times. Treated plasma volume summed to ( 6 142.3±112.09)L. Results:The combination rate of immunoglobulin and completement by blood single passing through the immunoadsorption column was (95.1±4.0)% for IgG,(38.8±10.3)% for IgM, (25.2±13.7)% for IgA, (14.1±9.4)% for C 3,and (12.1±0. 71)% for C 4. The mean reduction rate of serum level after each treatment was ( 63.1±16.5)% for IgG, (25.2±13.7)% for IgA, (30.8±10.3)% for IgM, (14.1 ±9.4)% for C 3, and (12.1±10.7)% for C 4 . Remissions were found in 7 S LE patients after treatments, with ANA and anti-ds-DNA antibody changing to ne gative in 50% patients. Among 5 patients with anti-GBM disease, 3 presented wit h anti-GBM antibody negative after treatments till to 4 months, one presented w ith antibody reducing by 62.8% after the first period of treatments, and reduci ng to negative after the second period of treatments, one of four patients requi ring hemodialysis before immunoadsorption treatments recovered renal function an d indepanded on hemodialysis after treatments. 6 of 10 patients with acute rejec tion post-transplantation obtained normal renal function after treatments, and 4 lost grafts. Immunoadsorption therapy decreased high level of PRA in one patie nt who received a second transplantation, and whose graft function remained stab le in two-years follow-up period. Serum apoE level decreased, and proteinuria decreased significantly in 7 patients with liponephropathy after treatments. The improvements of clinical conditions and renal function by immunoadsorption were observed in all the other patients except one with drug intoxication. Conclusion:Native protein A-based immunoadsorption apparatus is effective in removal of Ig G and other immunoglobulin, completement, and is contributed to alleviation of s ome damages resulted from active autoimmune diseases. Less cost and few complica tions will make it more widely applied in clinical practice.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2004年第5期408-413,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
全军首批临床高新技术重大项目 (No :2 0 0 2 18)
关键词
免疫吸附
临床应用
肾脏病
治疗
immunoadsorption immunoglobulin G anti-GBM disease renal transplantation
