中华眼底病杂志

中华眼底病杂志

血浆置换治疗视神经脊髓炎相关视神经炎值得注意的问题

查看全文

血浆置换(PE)是利用血细胞分离机在体外将患者血液分离成血浆和血细胞成分,弃去含有害致病物质的血浆,用等量置换液代替,再将血细胞成分和血浆置换液一起回输到患者体内的一种治疗性血液成分置换治疗方法;通过降低循环中的抗体、异常血浆蛋白或细胞因子等致病性大分子物质从而改善疾病进程。PE治疗对首次发病但糖皮质激素治疗抵抗的视神经脊髓炎相关视神经炎(NMO-ON)有良好的治疗效果。美国血浆透析学会临床治疗指南将PE治疗急性期视神经炎评价为推荐等级1B,Ⅱ类适应证推荐。在开展PE治疗NMO-ON等疾病时,应把严格握好治疗适应证与禁忌症,规范优化治疗流程与方案,重视常见不良事件及其预防和管理。开展多中心临床合作及高水平的临床随机对照研究,进一步深入探讨PE治疗NMO-ON的时间窗、最优方案和治疗方式、疗效及预后的影响机制是今后值得注意的问题。

Plasma exchange (PE) is a therapeutic blood component replacement method. The blood of patients is first separated into plasma and blood cell components using a blood cell separator in vitro, the plasma containing harmful pathogenic substances is then discarded and replaced with the same volume of exchange solution. Finally the separated blood cells together with the exchange solution are returned back to the blood circulation of patients. By reducing the circulating antibodies, abnormal plasma proteins or cytokines and other pathogenic molecules, PE can block the disease process. PE has a good therapeutic effect on neuromyelitis optica-related optic neuritis (NMO-ON), which shows resistant to glucocorticoid therapy for the first onset. The American Society for Apheresis guideline evaluates PE for acute optic neuritis as a recommended grade 1B, type II indication. In the implementation of PE treatment for NMO-ON and other diseases, indications and contraindications should be strictly adhered to the guideline, treatment procedures and protocols should be optimized, common adverse events and its prevention and management should be known and alerted. It is important to conduct multi-center clinical cooperation and a high standard clinical randomized controlled study, to find out the optimal time window, the best protocol, and the associated factors for the efficacy and prognosis of PE in NMO-ON.

关键词: 视神经脊髓炎/治疗; 视神经炎/治疗; 血浆置换; 述评

Key words: Neuromyelitis optica/therapy; Optic neuritis/therapy; Plasma Exchange; Editorial

引用本文: 谭少英, 魏世辉, 徐全刚, 庄远. 血浆置换治疗视神经脊髓炎相关视神经炎值得注意的问题. 中华眼底病杂志, 2017, 33(5): 445-448. doi: 10.3760/cma.j.issn.1005-1015.2017.05.002 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Morgan SM, Shaz BH, Pavenski K, et al. The top clinical trial opportunities in therapeutic apheresis and neurology[J]. J Clin Apher, 2014, 29(6): 331-335. DOI: 10.1002/jca.21339.
2. Okafor C, Ward DM, Mokrzycki MH, et al. Introduction and overview of therapeutic apheresis[J]. J Clin Apher, 2010, 25(5): 240-249. DOI: 10.1002/jca.20247.
3. Optic Neuritis Study Group. The clinical profile of optic neuritis: experience of the Optic Neuritis Treatment Trial[J]. Arch Ophthalmol, 1991, 109(12): 1673-1678.
4. Sepúlveda M, Armangué T, Sola-Valls N, et al. Neuromyelitis optica spectrum disorders: comparison according to the phenotype and serostatus[J/OL]. Neurol Neuroimmunol Neuroinflamm, 2016, 3(3): 225[2016-04-14]. http://europepmc.org/abstract/MED/27144216. DOI: 10.1212/NXI.0000000000000225.
5. Optic Neuritis Study Group. Visual function 15 years after optic neuritis: a final follow-up report from the Optic Neuritis Treatment Trial[J]. Ophthalmology, 2008, 115(6): 1079-1082. DOI: 10.1016/j.ophtha.2007.08.004.
6. Schwartz J, Padmanabhan A, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the seventh special issue[J]. J Clin Apher, 2016, 31(3): 149-162. DOI: 10.1002/jca.21470.
7. Wingerchuk DM. Neuromyelitis optica: new findings on pathogenesis[J]. Int Rev Neurobiol, 2007, 79: 665-688. DOI: 10.1016/S0074-7742(07)79029-3.
8. Takahashi T, Fujihara K, Nakashima I, et al. Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO: a study on antibody titre[J]. Brain, 2007, 130(Pt 5): 1235-1243. DOI: 10.1093/brain/awm062.
9. Hinson SR, McKeon A, Fryer JP, et al. Prediction of neuromyelitis optica attack severity by quantitation of complement-mediated injury to aquaporin-4-expressing cells[J]. Arch Neurol, 2009, 66(9): 1164-1167. DOI: 10.1001/archneurol.2009.188.
10. Merle H, Olindo S, Jeannin S, et al. Treatment of optic neuritis by plasma exchange (add-on) in neuromyelitis optica[J]. Arch Ophthalmol, 2012, 130(7): 858-862. DOI: 10.1001/archophthalmol.2012.1126.
11. Lehmann HC, Hartung HP, Hetzel GR, et al. Plasma exchange in neuroimmunological disorders: part 1: rationale and treatment of inflammatory central nervous system disorders[J]. Arch Neurol, 2006, 63(7): 930-935. DOI: 10.1001/archneur.63.7.930.
12. Kim SH, Kim W, Huh SY, et al. Clinical efficacy of plasmapheresis in patients with neuromyelitis optica spectrum disorder and effects on circulating anti-aquaporin-4 antibody levels[J]. J Clin Neurol, 2013, 9(1): 36-42. DOI: 10.3988/jcn.2013.9.1.36.
13. Reeves HM, Winters JL. The mechanisms of action of plasma exchange[J]. Br J Haematol, 2014, 164(3): 342-351. DOI: 10.1111/bjh.12629.
14. Magaña SM, Keegan BM, Weinshenker BG, et al. Beneficial plasma exchange response in central nervous system inflammatory demyelination[J]. Arch Neurol, 2011, 68(7): 870-878. DOI: 10.1001/archneurol.2011.34.
15. Bonnan M, Valentino R, Olindo S, et al. Plasma exchange in severe spinal attacks associated with neuromyelitis optica spectrum disorder[J]. Mult Scler, 2009, 15(4): 487-492. DOI: 10.1177/1352458508100837.
16. Yoshida H, Ando A, Sho K, et al. Anti-aquaporin-4 antibody-positive optic neuritis treated with double-filtration plasmapheresis[J]. J Ocul Pharmacol Ther, 2010, 26(4): 381-385. DOI: 10.1089/jop.2009.0150.