粒细胞吸附分离性输血治疗伴有类风湿性关节炎患者的下肢溃疡:3例成功治疗病例报道

作     者：Mori S. Nagashima M. Yoshida K. S. Yoshino 刘超 

作者机构：Dept. of Joint Disease/Rheumatism Nippon Medical School 1- 1- 5 Sendagi Bunkyo-ku Tokyo 113- 8603 JapanDr. 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2005年第1卷第3期

页      面：13-14页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：类风湿性关节炎 细胞吸附 输血治疗 下肢溃疡 分离性 血管炎 炎症细胞因子 坏疽性脓皮病 商品名 单核巨噬细胞 

摘      要：Background. The treatment of inflammatory leg ulcers complicated by r heumatoi d arthritis (RA), which are unresponsive to conventional care, can be frustratin g. Furthermore, as granulocytes and monocytes (GM) are major sources of inflamma tory cytokines, they have the potential to initiate and perpetuate in-flammato ry skin lesions. Accordingly, a recent study reported the remission of pyoderma gangrenosum following the reduction of activated peripheral blood GM by adsorpti ve apheresis (GMA). Methods. In this clinical study, we applied GMA to three cas es, each with one leg ulcer below the knee and RA. The ulcers had not responded to conventional therapy, including disinfection, dressing, and antimicrobials, a nd therefore were thought to represent inflammatory vasculitic lesions. GMAwas p erformed using a column with a capacity of 335mL, filledwith cellulose acetate b eads that selectively adsorb granulocytes and monocytes/macrophages (Adacolumn). Each patient received one GMA session/week for five consecutive weeks. The dura tion of one session was 60 min, with a flow rate of 30 mL/min. Results. The ulce rs began to recede after two GMA sessions and, by the end of the fifth session, the ulcers in all three patients had healed. No recurrence has been observed up to the time of this report. The treatmentwas well tolerated and no severe sideef fects were observed. Conclusions. GMA, which depletes activated neutrophils and monocytes/macrophages, appears to be effective for inflammatory skin ulcers whic h do not respond to conventionalmedications.