Endoscopic findings can predict the efficacy of leukocytapheresis for steroid-naive patients with moderately active ulcerative colitis

AIM：To investigate the therapeutic usefulness of leukocytapheresis （LCAP; Cellsoba） in steroid-naive patients with moderately active ulcerative colitis （UC）. METHODS： Eighteen steroid-naive patients with moderately active UC received one LCAP session every week for fi ve consecutive weeks. RESULTS： The remission rate 8 weeks after the last LCAP session was 61.1% （11/18）. All three patients with deep ulcers showed worsening after LCAP. For the remaining 15 patients, who had erosions or geographic ulcers, the average clinical activity index （CAI） score dropped significantly from 9.4 to 3.8 eight weeks after the last LCAP session （t = 4.89, P = 0.001）. The average C-reactive protein （CRP） levels before and after LCAP were 1.2 mg/dL and 1.0 mg/dL, respectively. Of the patients with erosions, geographic ulcers, and deep ulcers, 100% （9/9）, 33.3% （2/6）, and 0% （0/3） were in remission 8 weeks after the last LCAP session, respectively （χ2 = 7.65, P 〈 0.005）. Forty- eight weeks after the last LCAP session, the remission rates for patients with erosions and geographic ulcers were 44.4% （4/9） and 16.7% （1/6）, respectively. Only one patient suffered a mild adverse event after LCAP （nausea）. CONCLUSION： LCAP is a useful and safe therapyfor steroid-naive UC patients with moderate disease activity. Moreover, the effi cacy of the treatment can be predicted on the basis of endoscopic fi ndings.     

Decrease of reactive-oxygen-producing granulocytes and release of IL-10 into the peripheral blood following leukocytapheresis in patients with active ulcerative colitis

AIM: To investigate the clinical efficacy of leukocytapheresis (LCAP) in patients with active ulcerative colitis (UC), and to elucidate the mechanisms by determining the changes in the cytokine levels in the peripheral blood and of the functions of the peripheral blood leukocytes in these patients. METHODS: The subjects were 19 patients with active UC, with a mean clinical activity index (CAI) of 9.2. The LCAP was conducted using Cellsorba E. In each session of LCAP, 2-3 L of blood at the flow rate of 30-50 mL/min was processed. The treatment was carried out in approximately 1-h sessions, once a week, for 5-10 wk. Blood samples for determination of the cytokine levels were collected from the inflow side of the column (site of dehematization; at the start of LCAP) and outflow side of the column (at the end of LCAP). Blood samples for the determination of reactive-oxygen-producing cells were collected from the peripheral blood before and after LCAP. RESULTS: LCAP resulted in clinical improvement in all the 19 patients of UC recruited for this study. Remission (CAI: ≤4) was noted in 15 (79%) of the 19 patients. The blood level of the pro-inflammatory cytokine IL-6 was found to be decreased following treatment by LCAP, and the level of the anti-inflammatory cytokine IL-10 at the outflow side of the LCAP column was found to be significantly elevated as compared to that at the inflow side of the column. The reactive-oxygen-producing granulocytes in the peripheral blood of UC patients was increased as compared to that in healthy persons and the increase was found to be decreased following treatment by LCAP. CONCLUSION: LCAP exerted a high therapeutic efficacy in patients with active UC. Our findings suggest that LCAP is associated with enhanced production of the inhibitory cytokine IL-10 to indirectly inhibit the functions of the inflammatory leukocytes, and that inflammation is also considerably attenuated by the direct removal of reactive-oxygen-producing neutrophils from the peripheral blood.     

Modulation of platelet aggregation responses by leukocytapheresis therapy in patients with active ulcerative colitis

Background Recent studies suggest that platelet activation plays an important role in the pathophysiology of inflammatory bowel disease. In this study, we evaluated the effects of leukocytapheresis (LCAP) on platelet functions in patients with ulcerative colitis (UC). Methods Thirteen patients with active UC (five women and eight men) were treated with LCAP therapy. Platelet-rich plasma (PRP) was prepared, and platelet aggregation in response to agonist solution (epinephrine, collagen, and ADP) was measured with a platelet aggregometer. Platelet-derived microparticle (PDMP) plasma levels were determined by enzyme-linked immunosorbent assay. Results Nine patients responded to LCAP therapy, but no clinical responses were observed in four patients. The aggregation response to 0.1 μg/ml epinephrine was enhanced in all patients. In all responders, enhanced epinephrine aggregation was normalized after the LCAP session. However, in the four nonresponders, enhanced epinephrine aggregation was maintained after the LCAP session. In responders, the mean maximum aggregation induced by 0.1 μg/ml epinephrine was 76.8 ± 5.0% before and 15.4 ± 3.8% after LCAP, respectively (P < 0.05). Increased aggregation responses to both 0.2 μg/ml collagen and 1.0 μM ADP were observed, and LCAP also normalized these enhanced responses. LCAP significantly reduced circulating PDMP levels (56.8 ± 28.3 U/ml before and 46.3 ± 30.4 U/ml after LCAP, P < 0.05). Conclusions LCAP reduced enhanced platelet aggregation responses in active UC patients. Because platelets play an important role in inflammatory and immune responses, therapeutic effects of LCAP may be partially mediated by reduction of increased platelet aggregation activities.     

局灶性节段性肾小球硬化的血液净化治疗

局灶性节段性肾小球硬化( focal segmental glomerul osclerosis,FSGS)是临床上常见的肾小球疾病,临床预后差.近20年来,有不少文献报道应用血浆置换( plasma exchange,PE)、双重滤过血浆净化(double filtration plasmapheresis,DFPP)、血浆及全血吸附(又分为物理化学吸附和免疫吸附)、白细胞去除疗法( leukocytapheresis,LCAP)在FSGS的治疗中起到了较好的效果.2010年卫生部《血液净化标准操作规程》已明确将FSGS作为血浆置换、免疫吸附治疗的适应证,日本已将FSGS的血液净化治疗纳入医疗保险支付范围.     

白细胞分离法治疗溃疡性结肠炎的研究进展

溃疡性结肠炎(UC)是一种慢性非特异性肠道炎性疾病,其发病机制尚未完全明确。该病的治疗一直是一个难题,部分难治性UC患者在传统药物治疗无效的情况下需转为外科手术治疗。近年来随着人们对UC发病机制的深入研究,选择性白细胞分离法(LCAP)逐渐成为治疗UC的有效方法之一。此文就LCAP治疗UC的研究进展作一综述。     

左侧隐匿性房室旁道频率依赖性室房传导及心动过速特点

报道4例经导管射频消融证实的左侧隐匿性房室旁道（LCAP）空房（VA）传导及心动过速特点。4例室上性心动过速患者均接受了心内电生理检查（EPS）：①4例均于右空心尖（RVA），其中1例于多个部位（右室流出道、左室及旁道在室端)行分级递增起搏（S1S1），观察VA传导情况；②于高位右房行S1S1及程控期前（S1S2）刺激诱发心动过速，观察有无房室给双径路。结果显示,RVA起搏经LCAP1：1VA传导窗口为40～120m，上限为400～350ms，下限为360～270ms；若RVA起搏周长在窗口之外，VA完全分离或偶经LCAP逆传。其中1例多部位起搏结果与RVA起搏结果相似。4例均对诱发心动过速，周长为330～360ms，但不能持续，A波逆传受阻于旁道而自动终止。提示LCAP若受到3相、4相阻滞或旁道之外如其他旁道竞争传导、房室结逆传干扰等因素的影响，可发生频率依赖性VA传导，EPS诱发的心动过速可能不持续。因此，认识这些特点，有助于LCAP的诊断，避免误诊、漏诊。     

激素冲击疗法联合免疫抑制剂治疗狼疮危象疗效观察

目的 观察激素冲击疗法联合免疫抑制剂治疗狼疮危象的临床疗效.方法 将49例狼疮危象患者分为观察组28例和对照组21例,观察组采用激素冲击疗法联合免疫抑制剂治疗,对照组单纯采用单纯激素冲击治疗,观察两组临床疗效.结果 观察组完全缓解14例、部分缓解11例、无效3例,缓解率为89.3％;对照组分别为3、10、8例和61.9％,两组缓解率比较P＜0.05.结论 激素冲击疗法联合免疫抑制剂治疗狼疮危象疗效较好.     

探讨糖尿病合理应用口服降糖药物临床效果观察

目的分析研究糖尿病合理应用口服降糖药物临床效果。方法为糖尿病患者服用口服降糖药物,观察其临床的治疗效果。结果通过对糖尿病患者口服降糖药进行治疗能够有效缓解并发症状,使其的生活质量得以提高。结论糖尿病患者合理应用口服降糖药物有较好的临床效果,值得在临床上推广并使用。     

中西医结合治疗盆腔炎性疾病90例临床分析

目的 探讨中西医结合治疗盆腔炎性疾病的疗效.方法 将门诊90例盆腔炎性疾病患者分为治疗组46例和对照组44例,治疗组用广谱抗生素结合中药灌肠加腹部微波治疗,对照组单用广谱抗生素治疗.结果 治疗组的临床有效率明显高于对照组(P＜0.01),其症状缓解时间也明显短于对照组(P＜0.05).结论 中西医结合治疗盆腔炎性疾病效果较好.     

MAGE基因在肺癌疫苗研究进展

随着对肿瘤逃避免疫监视机制研究的不断深入,免疫治疗已成为一种有希望治疗肿瘤的新方法.其中肿瘤疫苗作为肿瘤的特异性主动免疫治疗成为肺癌非常有吸引力的靶向治疗策略之一,尤其适用于完全切除术后患者的辅助治疗.近年来肿瘤疫苗是采用MAGE多肽、基因和树突状细胞等方法来免疫肺癌患者,在Ⅰ/Ⅱ期临床试验中已观察到免疫反应和肿瘤的缓解,并取得了较好的临床疗效评价.目前正在进行国际多中心临床研究进行论证.     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

高血压降压治疗目标的再认识

根据传统的高血压水平的定义,1993年WHO高血压治疗指南提出血压控制目标为<140/90mm Hg(1mm Hg=0.133kPa),但是并非所有患者都必须将血压降至同一水平,而应根据患者情况进行个体化治疗。Framingham进行的一项长达10～12年的心血管事件研究发现,第5年后,正常上限血压[收缩压(SBP     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.