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《Chinese Journal of Nephrology Dialysis & Transplantion》 2004-05
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Clinical application and effects of the protein A-b ased immunoadsorption

JI Daxi, GONG Dehua, REN Bing, XU Bing, LIU Yun, ZHANG Yidan, XI E Honglang, TAO Jing, HU Weixing, LIU Zhihong, LI Leishi Reseach Institute of Nephrology, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002  
Objective:To observe the clinical application and effect of immunoadsorption in severe pat ients treated by a native protein A-based apparatus. Methodology:Thirty-six patients with various diseases including 7 cases of systemic lupus e rythematosus (SLE), 5 anti-glomerular basement membrane (GBM) disease, 10 acute rejection after renal transplantation, 7 liponephropathy, one case due to high panel reactive antibodies (PRA) level (before receiving a second renal transplan tation), one membranoproliferative glomerulonephritis, one Henoch-Schnlein ne phritis, one cryoglobulinemic glomerulonephristis, one Sjgren's syndrome, one Guillain-Barre's syndrome and one case of drug intoxication were enrolled this study. All of them received immunoadsorption using a native genetic recombinatio n protein A-based apparatus (WCXJQ blood purification apparatus). In total 204 courses of immunoadsorption were performed in 36 cases, and average courses per case were 5.67 times. Treated plasma volume summed to ( 6 142.3±112.09)L. Results:The combination rate of immunoglobulin and completement by blood single passing through the immunoadsorption column was (95.1±4.0)% for IgG,(38.8±10.3)% for IgM, (25.2±13.7)% for IgA, (14.1±9.4)% for C 3,and (12.1±0. 71)% for C 4. The mean reduction rate of serum level after each treatment was ( 63.1±16.5)% for IgG, (25.2±13.7)% for IgA, (30.8±10.3)% for IgM, (14.1 ±9.4)% for C 3, and (12.1±10.7)% for C 4 . Remissions were found in 7 S LE patients after treatments, with ANA and anti-ds-DNA antibody changing to ne gative in 50% patients. Among 5 patients with anti-GBM disease, 3 presented wit h anti-GBM antibody negative after treatments till to 4 months, one presented w ith antibody reducing by 62.8% after the first period of treatments, and reduci ng to negative after the second period of treatments, one of four patients requi ring hemodialysis before immunoadsorption treatments recovered renal function an d indepanded on hemodialysis after treatments. 6 of 10 patients with acute rejec tion post-transplantation obtained normal renal function after treatments, and 4 lost grafts. Immunoadsorption therapy decreased high level of PRA in one patie nt who received a second transplantation, and whose graft function remained stab le in two-years follow-up period. Serum apoE level decreased, and proteinuria decreased significantly in 7 patients with liponephropathy after treatments. The improvements of clinical conditions and renal function by immunoadsorption were observed in all the other patients except one with drug intoxication. Conclusion:Native protein A-based immunoadsorption apparatus is effective in removal of Ig G and other immunoglobulin, completement, and is contributed to alleviation of s ome damages resulted from active autoimmune diseases. Less cost and few complica tions will make it more widely applied in clinical practice.
【Fund】: 全军首批临床高新技术重大项目 (No :2 0 0 2 18)
【CateGory Index】: R459.5
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