Double filtration plasmapheresis combined with glucocorticoid treatment for myasthenia gravis: symptom remission and variation of immune antibodies

doi:10.3969/j.issn.2095-4344.2015.08.015

Abstract

Abstract:

BACKGROUND: Double filtration plasmapheresis is an effective means for treatment of myasthenia gravis in recent years. There are many mechanisms underlying double filtration plasmapheresis for treatment of myasthenia gravis, but there is no unified understanding.

OBJECTIVE: To analyze the clinical effect of double filtration plasmapheresis combined with glucocorticoid treatment for myasthenia gravis.

METHODS: A total of 46 patients diagnosed as having advanced myasthenia gravis who were consecutively admitted were enrolled and randomized into experimental group (n=26) and control group (n=20). Patients in the control group received glucocorticoid treatment, and those in the experimental group received double filtration plasmapheresis combined with glucocorticoid treatment.

RESULTS AND CONCLUSION: The titers of anti-acetylcholine receptor antibody in the two groups were both decreased significantly after treatment (P < 0.05), especially in the experimental group (P < 0.01); but the IgA and IgM clearance rate in the experiment group were significantly higher than that in the control group (P < 0.01). The quantitative myasthenia gravis score, symptom remission time, in-hospital time in the experimental group were all significantly less than those in the control group (P < 0.01). What’s more, the total effective rate was significantly higher in the experimental group than the control group. The double filtration plasmapheresis combined with glucocorticoid treatment for myasthenia gravis is safe and effective that can effectively remove the anti-acetylcholine receptor antibody, IgA and IgM.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Glucocorticoids, Myasthenia Gravis, Antibodies

CLC Number:

R318

Han Qi, Sha Peng, Wang Yun-fu. Double filtration plasmapheresis combined with glucocorticoid treatment for myasthenia gravis: symptom remission and variation of immune antibodies[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(8): 1228-1232.

Figures/Tables 2

References

[1] 黄志新,黄志.糖皮质激素对儿童重症肌无力Th1/Treg细胞转录因子表达的影响及机制研究[J].重庆医科大学学报,2011,36(3): 302-305.
[2] 黄莹,赵重波,朱雯华,等.重症肌无力患者外周血白细胞糖皮质激素受体α、βmRNA表达与激素疗效的关系[J].复旦学报:医学版, 2012,39(1):31-35.
[3] 赵翀翀,王欢,蔡宏斌,等.糖皮质激素对重症肌无力患者相关免疫机制影响研究[J].中风与神经疾病杂志,2012,29(10):907-909.
[4] 陈海燕,邬步云,徐斌,等.双重血浆置换治疗中血清致病抗体清除效率与疗效的关系[J].肾脏病与透析肾移植杂志,2014,23(3): 235-239.
[5] 单永梅,崔俊,高春娟,等.双重血浆滤过治疗狼疮性肾炎并发血栓性微血管病患者的护理[J].解放军护理杂志,2012,29(1B): 31-34.
[6] 王惟信.双膜法血浆滤过治疗重症肌无力的疗效和可能机制探讨[D].复旦大学,2009.
[7] 张智敏,钟汉生,余洋,等.双重滤过血浆置换降低高群体反应性抗体的研究[J].四川医学,2013,34(2):176-177.
[8] Tesar V,Hruskova Z.ANCA-associated renal vasculitis-an update．Contrib Nephrol.2013;181(1):216-228．
[9] Cartin-Ceba R, Peikert T, Specks U.Pathogenesis of ANCA-associated vasculitis. Curr R heumatol Rep.2012；14(6):481-493．
[10] Geetha D, Seo P. Advances in therapy for ANCA-associated vasculitis. Curr R heumatol Rep.2012;14(6):509-515．
[11] Kallenberg CG.Treatment of ANCA-associated vasculitis，where to go?.Clin Rev Allergy Immunol.2012;43(3):242-248．
[12] Berden A, Goceroglu A, Jayne D, et al. Diagnosis and management of ANCA associated vasculitis.BMJ.2012;344: e26.
[13] Wilde B, van Paassen P, Witzke O, et al. New pathophysiological insights and treatment of ANCA-associated vasculitis. Kidney Int.2011;79(6):599-612.
[14] Kallenberg CG.Pathophysiology of ANCA-associated small vessel vasculitis．Curr Rheumatol Rep.2010;12(6):399-405．
[15] Mohan N, Kerr GS.Kerr, ANCA-associated small vessel vasculitis:clinical and therapeutic advances. Curr Rheumatol Rep.2010;12(6):406-413．
[16] Liu JF, Wang WX, Xue J, et al. Comparing the autoantibody levels and clinical efficacy of double filtration plasmapheresis，immunoadsorption，and intravenous immunoglobulin for the treatment of late-onset myasthenia gravis.Ther Apher Dial. 2010;14(2):153-160．
[17] 陈樱花,龚德华,刘正钊,等.双重血浆置换治疗抗中性粒细胞胞质抗体相关血管炎严重肾损害的临床疗效[J].肾脏病与透析肾移植杂志, 2012, 21(1):8-13．
[18] Gong D, Ji D, Xu B, et al.More selective removal of myeloperoxidase-anti-neutrophil cytoplasmic antibody from the circulation of patients with vasculitides using a novel double-filtration plasmapheresis therapy.Ther Apher Dial. 2013;17(1):93-98．
[19] Higgins R, Lowe D, Hathaway M, et al.Double filtration plasmapheresis in antibody-incompatible kidney transplantation. Ther Apher Dial.2010;14(4):392-399.
[20] Hanafusa N. Theoretical basis of pathogenic substance removal during plasmapheresis.Ther Apher Dial.2011;15(5): 421-430.
[21] Tang S, Lai KN. Chronic viral hepatitis in hemodialysis patients. Hemodial Int. 2005;9(3):169-179.
[22] Su Y, Yan R, Duan Z, et al. Prevalence and risk factors of hepatitis C and B virus infections in hemodialysis patients and their spouses: a multicenter study in Beijing, China. J Med Virol .2013:85: 425-432.
[23] Fabrizi F, Lunghi G, Ganeshan SV, et al.Hepatitis C virus infection and the dialysis patient. Semin Dial.2007;20: 416-422.
[24] Betjes MG. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol. 2013;9: 255-265 .
[25] Cohen G, Horl WH.Immune dysfunction in uremia—an update. Toxins (Basel) .2012);4: 962-990.
[26] Fujiwara K, Kaneko S, Kakumu S, et al. Double filtration plasmapheresis and interferon combination therapy for chronic hepatitis C patients with genotype 1 and high viral load. Hepatol Res. 2007; 37: 701-710.
[27] Saison J, Demaret J, Venet F, et al. CD4+CD25+CD127- assessment as a surrogate phenotype for FOXP3+ regulatory T cells in HIV-1 infected viremic and aviremic subjects. Cytometry B Clin Cytom . 2013;84: 50-54.
[28] Poynard T, Yuen MF, Ratziu V,et al. Viral hepatitis C. Lancet. 2003;362:2095-2100.
[29] Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int. 2004; 65: 2335-2342.
[30] Huraib S, al-Rashed R, Aldrees A,et al. High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies. Nephrol Dial Transplant. 1995;10: 470-474.
[31] Okuda K, Yokosuka O.Natural history of chronic hepatitis C in patients on hemodialysis: case control study with 4-.23 years of follow-up. World J Gastroenterol. 2004;10:2209-2212.
[32] Fabrizi F, Dixit V, Messa P, Martin P.Interferon monotherapy of chronic hepatitis C in dialysis patients: meta-analysis of clinical trials. J Viral Hepat. 2008;15:79-88 .
[33] Perico N, Cattaneo D, Bikbov B,et al. Hepatitis C infection and chronic renal diseases. Clin J Am Soc Nephrol.2009;4: 207-220.
[34] Vacher-Coponat H, Brunet C, Lyonnet L, et al. Natural killer cell alterations correlate with loss of renal function and dialysis duration in uraemic patients. Nephrol Dial Transplant 2008;23:1406-1414 .
[35] Lim WH, Kireta S, Leedham E, et al. Uremia impairs monocyte and monocyte-derived dendritic cell function in hemodialysis patients. Kidney Int.2007;72:1138-1148 .
[36] Meijers RW, Litjens NH, de Wit EA, et al. Uremia causes premature ageing of the T cell compartment in end-stage renal disease patients. Immun Ageing. 2012;9:19.
[37] Libetta C, Esposito P, Sepe V, et al. Dialysis treatment and regulatory T cells. Nephrol Dial Transplant.2010;25: 1723-1727 .
[38] Lanier LL .Evolutionary struggles between NK cells and viruses. Nat Rev Immunol. 2008;8:259-268.
[39] Levent F.Double filtration plasmapheresis in combination with interferon therapy for chronic hepatitis C. Hepatol Res. 2011; 41:197.
[40] Kaneko S, Sata M, Ide T, et al. Efficacy and safety of double filtration plasmapheresis in combination with interferon therapy for chronic hepatitis C. Hepatol Res.2010;40: 1072-1081.
[41] Kondo Y, Ueno Y, Shimosegawa T.Double filtration plasmapheresis could induce a favorable immune response for chronic hepatitis C therapy. Ther Apher Dial. 2012;16: 478-479.
[42] Kondo Y, Ueno Y, Wakui Y, et al. Rapid reduction of hepatitis C virus-Core protein in the peripheral blood improve the immunological response in chronic hepatitis C patients. Hepatol Res. 2011;41:1153-1168.
[43] Perrella A, Vitiello L, Atripaldi L,et al. Elevated CD4+/CD25+ T cell frequency and function during acute hepatitis C presage chronic evolution. Gut. 2006;55:1370-1371.