血浆置换联合DNA免疫吸附血液灌流治疗难治性系统性红斑狼疮

2003年2月-2005年3月，用血浆置换联合DNA免疫吸附血液灌流治疗难治性系统性红斑狼疮（SLE），疗效满意，报告如下。     

血浆置换治疗系统性红斑狼疮体会

血浆置换治疗系统性红斑狼疮体会暨南大学医学院肾内科（５１０６３２）林日英，尹良红，郑绮宜系统性红斑狼疮是一种自身免疫性疾病，常累及全身多个器官，特别是皮肤，关节和肾脏，血清中有多种自身抗体，特别是抗核抗体，抗双链ＤＮＡ抗体是本病的特征性标志。病程迁延...     

系统性红斑狼疮血浆置换的护理体会

血浆置换(简称PE)临床应用是近几十年来医学领域里新发展起来的一项治疗措施。PE是将患者分离出的血浆弃除,并补充一定量的血浆,以清除体内可溶性免疫复合物和抗基膜抗体以及血浆中其他免疫活性物或蛋白结合的毒物。临床上针对系统性红斑狼疱(SLE)的免疫发病机理,应用免疫抑制剂结合PE,使治疗上可获得较长时期缓解。     

DNA 230血浆免疫吸附治疗重症系统性红斑狼疮的护理

总结19例重症系统性红斑狼疮病人采用DNA230血浆免疫吸附治疗的护理。护理重点为治疗前病人的心理评估、心理疏导、深静脉置管护理、并发症的预防及护理。19例病人完成2～5次血浆吸附,治疗后临床症状改善,抗ds-DNA抗体滴度较前显著下降,无不良反应发生。     

血浆置换治疗系统性红斑狼疮37例的护理

系统性红斑狼疮 (systemiclupuserythmatosus,SLE)是一种累及多系统、多器官 ,具有多种自身抗体的自身免疫性结缔组织病。本病以青年女性多见 ,血浆置换 (PlasmaExchangPE)作为一种新的治疗方法已用于临床上多种疾病的治疗 ,它能去除血浆中的病理成份 ,将正常成份回输给病人 ,同时输入等量的血浆替代品 ,通过交换能减少血浆中的可溶性免疫复合物、抗基底膜抗体以及其他免疫活性物质[1 ] ,达到治疗的目的。我院从 1 997年开始至今对 37例SLE病人进行血浆置换 1 0 3次 ,使SLE临床症状得到了有效的控制。现将护理介绍如下。1　临床资料1 …     

血浆置换并中西医结合治疗重症系统性红斑狼疮

系统性红斑狼疮 (systemic lupus erthematosus,SL E)是一种具有多种自身抗体的自身免疫性疾病。目前对重症系统性红斑狼疮 (SSL E)尚无理想疗法。我们探索用血浆置换 (plasma ex-change,PE)并中西医治疗 7例 SSL E,取得满意临床效果 ,报道如下。1　材料和方法1.1　病例选择　 7例 SSL E均为住院患者 ,男 1例 ,女 6例 ,年龄 2 1～ 35岁。均符合美国风湿学会 1982年修订的 SL E诊断标准。其中 5例为狼疮危象[1 ] ,2例为急进性狼疮性肾炎[1 ] ,病程 5天至 3年 ,7例患者均有蛋白尿 ,5例狼疮危象者肾脏病理类型为 3例系膜增生、1例微小…     

血浆置换治疗系统性红斑狼疮10例的护理

系统性红斑狼疮是一种自身免疫性结缔组织病，由于患者体内有大量致病性自身抗体和免疫复合物，造成组织损伤，临床可出现全身多系统和脏器损害的症状。我科应用血浆置换治疗系统性红斑狼疮患者取得显著效果，现介绍如下。     

系统性红斑狼疮患者行血浆置换的临床观察及护理

传统性红斑狼疮（ＳＬＥ）是一种具有多种自身抗体的自身免疫性疾病，用血浆置换（ＰＥ）可迅速去除ＳＬＥ患者循环系统中的抗原、抗体和免疫复俣物，使患者的病情能迅速得到缓解或控制。在ＰＥ治疗过程中护理工作是非常重要的，我们通过严密的观察、早期预防及护理，保证了ＰＥ的顺利进行，有效地预防了并发症的发生，提高了治疗效果，使患者的病情得到及时地控制和缓解。     

血浆置换治疗系统性红斑狼疮并发症28例护理体会

目的:探讨血浆置换(PE)治疗系统性红斑狼疮(SLE)的护理措施。方法:回顾2003~2005年住院的SLE患者28例62次PE治疗的临床资料,分析常见并发症及其原因,有针对性地进行护理干预。结果:PE治疗常见并发症有低血压、过敏反应、出血及感染。结论:针对相关因素有预见性地及时正确地采取护理措施,能最大限度地减少并发症发生。     

蛋白A免疫吸附治疗系统性红斑狼疮1例

报告1例应用蛋白A免疫吸附治疗系统性红斑狼疮病人的个案,总结治疗的护理要点,包括治疗前病人评估与用物准备,治疗中预冲、吸附、回浆、洗脱、平衡、二次预冲循环过程的操作、病情观察及吸附柱的储存,治疗结束后的治疗效果评价。通过该病例的护理总结,为临床应用蛋白A免疫吸附治疗系统性红斑狼疮的护理提供参考。     

不同免疫吸附方法治疗系统性红斑狼疮的对比研究

目的比较A蛋白免疫吸附、PH350免疫吸附、DNA免疫吸附对系统性红斑狼疮的治疗效果。方法 98例系统性红斑狼疮患者,根据选择免疫吸附治疗的方式分为3组,观察治疗前后患者尿蛋白定量、血肌酐、尿素氮、白蛋白、免疫球蛋白、补体、自身抗体(抗核抗体、抗双链DNA抗体)、活动指数、器官功能等。结果治疗前后比较,患者尿蛋白定量、血肌酐、尿素氮、免疫球蛋白、自身抗体显著下降(均P0.05),其中A蛋白吸附与其他两种治疗方法免疫球蛋白清除率差异有统计学意义(均P0.05)。随观察时间的延长,不同方法的狼疮活动控制情况差异无统计学意义(P0.05)。结论不同免疫吸附治疗方法均可对系统性红斑狼疮取得较好的病情控制效果,但A蛋白对自身抗体清除更彻底。在临床实践中应综合考虑,选择最佳治疗方案。     

Evidence for a therapeutic effect of plasmapheresis in patients with systemic lupus erythematosus.

Fourteen patients with active systemic lupus erythematosus (SLE) have been treated with plasmapheresis at a rate of two litres daily on three to four days per week, over a period of two to three weeks. Plasma was replaced isovolemically with either fresh frozen plasma or with human plasma protein fractions. Ten patients were receiving treatment with prednisone at the time of plasmapheresis, and four had received no prior treatment. Eight patients showed evidence of either clinical improvement or clinical and immunochemical improvement, at the time of plasmapheresis. In the three patients who showed high levels of circulating complexes before treatment, there was a sudden fall in the level of circulating immune complexes, which was quantitatively greater than could be explained by the amount removed. This suggests that in some patients with SLE, clearance of complexes by the mononuclear phagocytic system is initially blocked by high levels of circulating complexes and that one effect of plasmapheresis may be to relieve this blockade. Five patients showed a clinical response to plasmapheresis despite the fact that tests for immune complexes were negative. Three patients showed no response to plasmapheresis, and three were regarded as unevaluable. In a limited number of patients, who show a high level of circulating immune complexes, and whose condition is deteriorating despite treatment with corticosteroids, there may be an important therapeutic role for plasmapheresis.     

Cyclosporin and plasmapheresis in treatment of progressive systemic lupus erythematosus (pSLE)

The prognosis of patients suffering from progressive systemic lupus erythematosus (pSLE) is poor, despite treatment with intensive drug regimens with combinations of corticosteroids, azathioprine and cyclophosphamide. Side-effects such as infections and malignomas often occur. In the present trial, 21 patients (four male, 17 female, aged 37.9 +/- 12.8) suffering from pSLE for 9.4 +/- 2.6 years, were treated for 2.3 +/- 1.8 years with drug regimens as mentioned above. Then, over a period of 6.4 +/- 2.6 (range 1-8) years, in addition to conventional therapies, cyclosporin (2.5 +/- 0.6 mg/kg body wt/d) and, in active stages of the disease with extremely high concentrations of anti-ds-DNA-, anti-nuclear antibodies and circulating immunocomplexes, plasmapheresis (therapeutic plasma exchange (TPE)) have been applied. Compared with previous treatment modalities, significantly (P < 0.05) more effective and rapid reduction of antibodies was achieved. Clinical symptoms improved within 2 to 4 weeks. Under the new therapeutic regimen all patients reported increased performance and a better quality of life. After 5 to 48 (17.5 +/- 13.8) months, cyclosporin was established as mono-therapy for 8/21 patients. In] the other cases, corticosteroids, azathioprine and cyclophosphamide were reduced by 40 to 100%. No severe side-effects were seen. In acute stages of pSLE and in forms with persistently high antibody levels, the addition of TPE to conventional therapy was very effective, with regard to improving both clinical and laboratory parameters.     

Epratuzumab for systemic lupus erythematosus

Introduction: Systemic lupus erythematosus is an autoimmune multiorgan disease in which the lack of an appropriate therapy can lead to rapid organ failure and death. Immunosuppressive therapies such as corticosteroids or cyclophosphamide can slow down the disease progression but sometimes other therapies are needed. Among such therapies, epratuzumab, an antiCD22 antibody, can be potentially efficacious in this disease.

Areas covered: Discussion of the results from clinical studies evaluating the efficacy and safety of epratuzumab in patients with moderate or severe systemic lupus erythematosus.

Expert opinion: The study demonstrates that epratuzumab can improve the quality of life and can reduce the disease activity burden, but the premature termination of the studies might have limited the generation of further efficacy data.     

Development of an in vitro miniature model to simulate immunoadsorption in patients with systemic lupus erythematosus

In SLE, immunoadsorption is used as an adjuvant therapy; however, adsorption profiles and binding mechanisms have not yet been completely investigated. Using a minicolumn filled with the sorbent IMPH with or without the ligand phenylalanine, we developed a model simulating clinical conditions in a reduced scale with a constant ratio of plasma to column volume and a constant plasma flow at room temperature. By desorbing the column, the adsorption efficacy for different antibodies could be measured directly. We demonstrate that the adsorption rate can be increased by a low plasma flow and by covering the column surface. Double perfusion of the same column did not increase the amount of adsorbed antibodies. We further demonstrate that the carrier material without a ligand is unable to bind antibodies or protein. In the IMPH sorbent anti-dsDNA antibodies were significantly better adsorbed than total IgG or total protein. After a single perfusion of 21 samples, we estimated a mean anti-dsDNA antibody adsorption rate of 22.5% (+/-13.6). A group of ten responders with a medium adsorption rate of 35.4% (+/-6.5) clearly differed from a second group of eleven nonresponders (10.9% +/- 4.2). Anti-cardiolipin antibodies (ACA) were adsorbed in a wide range (IgG type, 2.5-52.7%, IgM type, 1.1-37.8%) while anti-Ro (SSA) antibody adsorption was negligible. This in vitro minimodel provides a precise simulation of therapeutic immunoadsorption and helps to analyze the binding characteristics of the sorbent IMPH and shows its effectiveness in several antibody subsets of different patients.