著者

渡辺,仁

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.24, no.1, 2005-02-28

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近年, 医療の面においてquality of life(以下QOL)が重要視されている.特に関節リウマチ(rheumatoid arthritis : RA)は, 慢性かつ進行性で激しい疼痛と肢体機能低下を伴う難治性の疾患であり, 関節の痛みだけでなく著しく関節の機能が障害されるため, 長期間の療養を必要とし患者のQOLは著しく低下しており, QOLの向上を目指した治療が最も重要視されている.現在, RAの治療は非ステロイド抗炎症剤, 抗リウマチ剤, 免疫抑制剤, ステロイド剤, また最近では生物学的製剤など複数の薬剤が組み合わせて使用されている.これら薬物療法に抵抗性を示す患者に対しては血漿交換療法(plasmapheresis : PP)も行われている.今回我々は, RAの治療法の一つであるPPがQOLに及ぼす影響について検討した.薬物療法に抵抗性であり1年以上継続的にPPを施行しているRA患者11名とし, Health Assessment Questionnaire(以下HAQ), Arthritis Impact Measurement Scale, ver.2(以下AIMS 2), 厚生省リウマチ調査研究事業のQOL研究班の評価案(NIH案)を参考に作成した調査票を用いて行った.今回の調査で長期間継続したPPによりRA患者のactivity of daily life (ADL), 快適度, 満足度だけでなく精神及び社会面などにおいても改善が認められた.長期間継続したPPはRA患者のQOLを高められると考えられた.

著者

面川,進

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.30, no.3, 2011-10-31

著者

中永,士師明

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.22, no.3, 2003-10-31

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Plasma exchange (PE) is a well-established blood purification therapy for treating fulminant hepatic failure. However, we previously reported that cytokines are not removed by PE alone, and combining PE and continuous hemodiafiltration (CHDF) is an effective modality for suppressing the elevation of blood citrate levels and for removing inflammatory cytokines. We devised a series-parallel method to raise the removal efficiency. In the series-parallel method, total bilirubin was significantly removed after treatment in comparison with the reverse-parallel method. Interleukin-18, which plays an important role in the pathophysiology of hepatic failure, was also significantly removed by the series-parallel method. The series-parallel method, which combines both advantages of the parallel and series methods, is a valuable therapy for the treatment of fulminant hepatic failure.

著者

矢萩 勝 長谷部 紀昭 高橋 倫彦 鈴木 昌幸

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.21, 2002

著者

人見,泰正

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.28, no.3, 2009-10-31

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膜型血漿分離器「エバキュアー」(Evacure;EC)を用いた単純血漿交換(Plasma filtration;PF)を持続的に施行して,ECの溶質透過性能の安定性等について検討した.症例は,劇症肝炎,術後肝不全,筋腎代謝症候群の各1例である.ECはEC-2A10(膜面積1.0m^2)を使用した.間歇的なPFにおけるミオグロビン,アルブミン(Alb)の篩係数(S.C.)を測定したところ,いずれの溶質についても経時的に安定した値が得られた.またAlb,ビリルビン(Bil),フィブリノゲンについて長時間のPFにおける経時変化を観察したところ,いずれの溶質についてもS.C.は血漿処理量14.4L時まで安定していた.AlbとBilはほぼ同じS.C.を示した.ECは物質除去性能が安定しており,持続的に用いても有用物質の保持と不要物質の除去のバランスがとれた膜であることが示唆された.今後,肝不全等にも有用な選択肢であると考えた.

著者

村上,和子

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.21, no.3, 2002-10-31

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Donor apheresis was introduced into the Japanese Blood Program in 1986. Since then more than 15 million apheresis procedures, including plateletpheresis and plasmapheresis, have been performed on healthy volunteer donors at Japanese Red Cross blood centers. Donor apheresis has contributed much to securing the safety of blood for transfusion and to procuring source plasma for plasma products. Much effort has been made to establish safe and efficient procedures, especially to prevent accidents and complications related to apheresis. Based on the annual reports by the Japanese Red Cross over the past five years,104,554 adverse events resulted from 7,397,010 apheresis procedures, an occurrence rate of 1.41%. About 59%of events were vasovagal reactions. The occurrence rate for adverse events, except for cases of hematoma and citrate effects, has been similar to that for whole blood donation. No reports have been made about serious donor reactions or complications related to apheresis procedures. This is one main reason why apheresis has been widely accepted by voluntary blood donors. Now that the procedures for recruiting apheresis donors have been established, the retention and management of donors is a key issue.

出版者

日本アフェレシス学会

著者

城田 祐子 佐藤 寿伸 宮田 正弘 加藤 潔 二宮 本報 石井 智徳 佐々木 毅 伊藤 貞嘉

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.21, 2002

著者

中根,俊成

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌

巻号頁・発行日

vol.32, no.3, 2013-10-31

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Autoimmune autonomic ganglionopathy (AAG) is a disorder of isolated autonomic failure associated with antibodies to the nitotinic acetylcholine receptor of the autonomic ganglia resulting in severe orthostatic intolerance, syncope, constipation, gastroparesis, urinary retention, dry mouth, dry eyes, blurred vision and anhidrosis. The disorder is associated with and most likely caused by antibodies to gAChR. Antibodies to the gAChR are found in the serum of 50% of patients with the acute or subacute form of AAG, correlate to disease severity, and have been shown to pathogenic. In this study, we attempted to develop a novel technique to detect antibodies that bind to gAChR. We established a simple in vitro system termed GLIP (gaussia luciferase-reporter immunoprecipitation), which can detect protein-protein interactions with high sensitivity without using radioisotopes. Using this new method, we extensively reviewed the case histories with current clinical and laboratory evaluations that include testing for antibodies to a3 and b4 subunits of gAChR in serum available from the time of symptom onset. Here, we describe 7 patients with gAChR autoantibody and autonomic dysfunction. Our observations also suggest that autoimmune-mediated impairment of autonomic function may be partially reversible. Six of the 7 patients, except for case 6, improved in response to immunotherapy (e.g. PP, IVMP, IVIg, and immunosuppressant drugs) with symptomatic therapy. In our patients, improvement in neurological deficits occurred with treatment with considerable heterogeneity in the pattern of response. We interpreted the improvement in clinical symptoms correlated with the decrease in the levels of anti gAChR antibodies in each case. Some patients with seropositive AAG respond to treatment with IVMP, PP or IVIg, although when used as a single agent, subsequent treatments are required in patients to maintain the improvement. Previous anecdotal observations suggest that IVIg, PP, and a combined therapy might be efficacious in treating AAG. The more severely affect patients who did not respond to IVMP or PP monotherapy did benefit from combined therapy adding other first line therapy and immunosuppressant agents (prednisolone, tacrolimus, and azathioprine) and seemed to require prolonged immunotherapy for sustained clinical improvement in this study. These results suggest ongoing antibody production, not self-limited.

著者

Weber Maria Steffen Hans-M. Haupt Walter F. Becker Karin Brunner Richard Mahrle Gustav Borberg Helmut

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.16, no.1, pp.115-125, 1997

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Extracorporeal elimination therapy of metabolic diseases may be taken into consideration if the substrate to be removed is present in the circulation in an elevated concentration and if the endogenous synthe-sis rate does not exceed the amount of re-moval. Systemic amyloidoses are characte-rized by the presence of specific protein pre-cursor molecules in the serum. Polymeriza-tion leads to the formation of fibrils which are deposited as amyloid in the extracellular space. Depending on the variables of the disease to be treated, it may generally be possible to delay its progression, achieve a halt in progression or even initiate regression of amyloid deposition. Two patients, a mother and her son, 54 and 25 years of age, with familial amyloidosis due to the transthyretin met30 variant (Por-tuguese type), after a disease duration of 9 and 6 years, respectively, received regular plasma exchanges in two-week intervals over a period of P/2 years. Patients' plasma was exchanged at volumes of 155% and replaced by 5% human albumin solution. Transthyretin levels were reduced by 50 - 70% during each plasma exchange procedure. Clinical, neurological, opthalmological, laboratory, histological, and electron microscopical examinations were performed prior to, and after one year of plasma exchange therapy. The overall results indi-cate only slight progression in the older pa-tient and stability in the younger patient. Athird patient, 56 years of age, with immunglobulin-type (AL) amyloidosis due to monoclonal gammopathy of unknown significance, with cardiac involvement and rapid deterioration of renal function under chemotherapy was treated initially by plasma exchange over a period of 1 1/2 years without further cytotoxic treatment, and subsequently by Ig adsorption using protein A or anti-IgG columns. Para-protein levels were reduced to 20-25% of the pretreatment values by plasma exchange on two consecutive days. Renal function, clinical and echo-cardiographical signs of cardiac failure remained stable. Our experience having patients with two different forms of systemic amyloidosis sufficiently is encouraging to discuss the possible therapeutic role of extracorporeal elimination in delaying the progression of amyloidosis.

著者

大貫 順一

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.26, no.1, pp.101-120, 2007-02-28

著者

奥山 泰裕 山田 裕道 池田 志斈

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.27, no.2, pp.139-144, 2008-05-31

被引用文献数

1

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Toxic epidermal necrolysis (TEN) is one of the serious drug eruptions with a high mortality rate. TEN also may cause severe consequences such as visual or respiratory disorders. Therefore, immediate diagnosis and initiation of correct therapy are most important. Apheresis therapy including plasma exchange for the treatment of TEN has been approved by the National Health Insurance System in Japan from 2006, due to the accumulation of successfully treated TEN patients with apheresis. In this study, we summarized the TEN patients treated with apheresis in our country, and discussed the timing to recruit the apheresis, as well as the mechanisms of apheresis. These examinations will provide an insight into a more appropriate treatment modality for the patients with TEN.

著者

松浦 栄次 小林 和子 小池 隆夫

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.23, no.2, pp.167-175, 2004-05-31

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Oxidative stress is thought to be etiologically related to atherosclerosis. Experimental evidence clearly demonstrates the presence of oxidized LDL (oxLDL) in the intima of arteries and that it contributes to the initiation and progression of atherosclerotic lesions. We have recently demonstrated that oxLDL interacts with β2-glycoprotein I (β2-GPI) to form complexes and that these complexes circulate in the blood stream of patients not only with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) but also with other systemic inflammatory diseases. Our in vitro experiments showed that oxLDL quickly interacts with β2-GPI via specific ligands generated by oxidation, in which the negative charge of oxLDL is neutralized by the complex formed. It was also shown that β2-GPI/oxLDL complexes are taken up by macrophages via lgG anti-β2-GPI autoantibody-mediated phagocytosis. Thus, IgG immune complexes with oxLDL and β2-GPI are thought to be atherogenic and β2-GPI/oxLDL complexes maybe implicated as autoantigens relevant in autoimmune-mediated atherogenesis in APS patients. In contrast, a set of reports indicated that natural antibodies (mainly of the IgM class) derived from hyperlipidemic mice reduced the incidence of atherosclerosis in experimental models. Further study should elucidate whether IgG and/or IgM antibodies induced to oxLDL and β2-GPI/oxLDL complexes in APS are pathogenic or protective, or are an epiphenomenon in the development of arterial thrombosis.

著者

井上 昭彦 佐藤 尚文 尾形 敏郎 五十嵐 清美 野田 大地 良永 康雄 飯島 耕作

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.29, no.3, 2010-10-31

著者

金蔵 拓郎

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.27, no.2, pp.152-157, 2008-05-31

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Granulocyte and monocyte adsorption apheresis (GCAP), an extracorporeal apheresis instrument using a column containing cellulose acetate beads designed to remove pathogenic granulocytes, was initially approved for the treatment of ulcerative colitis. We, as dermatologists, first assessed the therapeutic efficacy of GCAP in a patient with pyoderma gangrenosum which is often associated with ulcerative colitis and obtained remarkable results. We started the clinical study to assess the effectiveness of GCAP for treating various skin diseases attributable to activated neutrophils and investigated the mechanisms underlying the adsorption of pathogenic neutrophils. The effect of GCAP was assessed in 40 patients with neutrophilic dermatoses. The mechanisms by which the instrument adsorbs activated neutrophils were investigated using an in vitro mini-column system that mimics the GCAP. Of 39 patients with skin lesions, 32 (82.1%) benefited from GCAP. Mac-1 (CD 11 b/CD 18) expression on the peripheral neutrophils, increased compared to normal subjects, was reduced by GCAP. In the mini-column system, neutrophil adsorption was inhibited significantly by treating plasma with EDTA to inactivate complement and blood cells with anti-human CD 11b monoclonal antibody. Based on these results, we strongly propose GCAP as a useful treatment modality for skin disorders attributable to activated neutrophils.

著者

下立 雄一 本谷 聡 大野 慶 奥 大樹 北川 翔 吉田 英敏 小川 秀久 乙黒 雄平 鈴木 肇 寺門 洋平 西岡 均 萩原 武 前田 聡 小澤 広 黒河 聖 中野渡 正行 今村 哲理

出版者

日本アフェレシス学会

雑誌

日本アフェレシス学会雑誌 (ISSN:13405888)

巻号頁・発行日

vol.29, no.1, pp.152-153, 2010-02-28