内科理论与实践

内科理论与实践 ›› 2022, Vol. 17 ›› Issue (06): 441-446.doi: 10.16138/j.1673-6087.2022.06.004

• 论著 • 上一篇    下一篇

粒细胞和单核细胞吸附分离治疗中-重度炎症性肠病的有效性及安全性分析

陈英a, 张晨莉a, 姚玮艳b()   

  1. a.上海交通大学医学院附属瑞金医院 全科医学科，上海 200025
    b.上海交通大学医学院附属瑞金医院 消化内科，上海 200025
  • 收稿日期:2022-06-03 出版日期:2022-12-30 发布日期:2023-02-27
  • 通讯作者: 姚玮艳 E-mail: ywy11419@rjh.com.cn

Efficacy and safety of selective granulocyte and monocyte adsorptive apheresis in treatment of moderate to severe inflammatory bowel disease

CHEN Yinga, ZHANG Chenlia, YAO Weiyanb()   

  1. a. Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine，Shanghai 200025, China
    b. Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine，Shanghai 200025, China
  • Received:2022-06-03 Online:2022-12-30 Published:2023-02-27

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摘要：

目的：探讨粒细胞和单核细胞吸附分离治疗（granulocyte and monocyte apheresis，GMA）对中-重度炎症性肠病（inflammatory bowel disease，IBD）患者的有效性和安全性。方法：分析2013年5月至2021年9月于我院接受GMA治疗的38例中-重度IBD患者的临床资料，其中溃疡性结肠炎（ulcerative colitis，UC）28例、克罗恩病（Crohn disease，CD）10例。比较治疗前及治疗结束后第2周时患者疾病临床活动度评分[梅奥评分（Mayo score）、CD活动指数（CD activity index, CDAI）]、内镜下活动度评分[UC内镜下严重指数（UC endoscopic index of severity，UCEIS）、梅奥内镜评分（Mayo endoscopic score, MES）、Baron评分、CD内镜下严重指数（CD endoscopic index of severity，CDEIS）]、实验室指标变化及不良反应情况。结果：38例IBD患者总体临床有效率为79%，临床缓解率为42%。28例UC患者中23例（82%）GMA治疗后有效，10例（36%）达到临床缓解；10例CD患者中7例（70%）GMA治疗后有效，6例（60%）达到临床缓解。UC患者中，GMA显著降低梅奥、UCEIS、MES、Baron评分；CD患者中，GMA显著降低CDAI评分、CDEIS评分（均P<0.05）。所有IBD患者中，GMA显著升高血红蛋白、白蛋白水平，降低C反应蛋白（C-reactive protein，CRP）水平及减少大便次数（P<0.05）；治疗前后的白细胞、中性粒细胞比例、淋巴细胞比例、单核细胞比例、血小板、红细胞沉降率（erythrocyte sedimentation rate，ESR）水平差异无统计学意义。未观察到GMA相关的严重不良事件。结论：GMA对中-重度IBD患者有效、安全性高，但考虑到病例数较少，仍需进行进一步更大样本及长期随访的随机对照研究。

关键词: 炎症性肠病, 溃疡性结肠炎, 克罗恩病, 粒细胞和单核细胞吸附分离, 梅奥评分, 克罗恩病活动指数

Abstract:

Objective To explore the efficacy and safety of granulocyte and monocyte apheresis(GMA) in the patients of moderate to severe inflammatory bowel disease(IBD). Methods Thirty-eight patients of moderate to severe IBD received GMA treatment at our hospital from May 2013 to September 2021 were enrolled, which included 28 cases of ulcerative colitis(UC) and 10 cases of Crohn disease(CD); and the data were analyzed retrospectively. The indexes including patients’ disease clinical activity scores [Mayo score, CD activity index(CDAI) score], endoscopic activity scores [UC endoscopic index of severity (UCEIS) score, Mayo endoscopic (MES) score, Baron score, CD endoscopic index of severity(CDEIS) score], changes in laboratory tests, and adverse events were compared before and 2 weeks after GMA treatment. Results After GMA treatment, the overall clinical response rate in 38 patients was 79% and remission rate was 42%; in which, the efficacy rate in 28 UC patients was 82%(n=23), and 10(36%) patients were in remission; the efficacy rate in 10 CD patients was 70% (n=7), and 6 (60%) cases were in remission. In UC patients, GMA significantly decreased Mayo score, UCEIS score, MES and Baron score. In CD patients, GMA significantly decreased CDAI score and CDEIS score(P<0.05). In all patients with IBD, GMA significantly increased the level of hemoglobin (Hb) and albumin (Alb), and reduced C-reactive protein (CRP) levels and defecate frequency (P<0.05). There was no significant difference in white blood cell (WBC), neutrophil (N)%, lymphocyte(L)%, monocyte (M)%, platelet (PLT) and erythrocyte sedimentation rate(ESR) level before and after treatment. The GMA-related severe adverse events were not observed. Conclusions GMA was effective and highly safe for the patients of moderate to severe IBD, while further randomized controlled trials in larger samples still need to be done as considering small case number in our research.

Key words: Inflammatory bowel disease, Ulcerative colitis, Crohn disease, Granulocyte and monocyte apheresis, Mayo score, Crohn disease activity index

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