臨牀消化器内科 Vol.31 No.6(2-2)


特集名 IBD治療のcritical point ― 私ならこうする
題名 潰瘍性大腸炎―5‒ASA経口薬では不十分な場合 (2) ステロイドよりCAPを優先する理由
発刊年月 2016年 06月
著者 福知 工 大阪府済生会中津病院消化器内科
著者 嶋津 啓二 東北大学大学院医学系腎臓内科
【 要旨 】 血球成分吸着療法(CAP)は炎症性腸疾患に対する免疫制御療法のなかでもっとも副作用が少ない.その一つである顆粒球単球吸着療法(GMA)は活動期潰瘍性大腸炎(UC)においてステロイド投与前,あるいは週2回法(intensive GMA)による治療成績の向上が報告されている.われわれはステロイド未投与の活動期UCにもサイトメガロウイルス(CMV)再活性化を伴う症例が存在し,そのような症例でも抗ウイルス薬未使用でintensive GMAは有効かつ安全であることを報告した.それでもわずらわしさよりGMAは敬遠されがちであるがsingle‒needle化しても効果と安全性は同等であり,ステロイド前のUCにさらに使いやすくなる治療となると思われる.
Theme How Do You Choose Treatment Strategies for IBD Patients with a Critical Situation?
Title Reasons for Performing Granulocytes and Monocytes Adsorptive Apheresis Prior to Corticosteroids Administration for Active Ulcerative Colitis
Author Takumi Fukuchi Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital
Author Keiji Shimazu Department of Nephrology, Tohoku University Graduate School of Medicine
[ Summary ] Granulocyte and monocyte adsorptive apheresis (GMA) using Adacolumns is a natural biologic therapy for selectively removing granulocytes/macrophages from peripheral blood to reduce the production of inflammatory cytokines. We reported that a twice‒weekly regimen (intensive) of GMA was effective and had no severe adverse effect in steroid‒naive patients or those with free ulcerative colitis (UC) even when steroid naivete/free active UC had a cytomegalovirus reactivation in the intestinal tract mucosa without administration of antiviral agents. However, conventional GMA may often be avoided in the treatment of active UC because of the need to maintain two blood access routes through the antecubital veins, which is required for the GMA system. Recently, we introduced a single‒needle technique for GMA and demonstrated no striking differences in the clinical responses and adverse effects between single‒ and double‒needle intensive GMA in steroid-naive patients or those with free active UC. Thus, the reasons for performing GMA prior to corticosteroid administration in patients with active UC are adequate efficacy as an alternative to corticosteroids, fewer severe adverse effects than corticosteroids, and to avoid the need to maintain two blood access routes for induction of the single‒needle technique.
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