| 特集名 | 全身性疾患における血液浄化療法 -- 急性期、および慢性期の対応 | |
|---|---|---|
| 題名 | 内分泌疾患(甲状腺クリーゼなど) | |
| 発刊年月 | 2001年 03月 | |
| 著者 | 冨永 芳博 | 名古屋第二赤十字病院腎臓病総合医療センター外科・血液浄化センター |
| 【 要旨 】 | 甲状腺クリーゼは甲状腺機能亢進症の症状が急速に悪化し，生命の危機に瀕した状態である．本症の治療の基本は過剰となった甲状腺ホルモンの低下にある．単純血漿交換療法はturnoverの長い甲状腺ホルモンを急速に除去することが可能で，意識障害，昏睡，ショックなどが改善しない重症例で適応となる．悪性眼球突出症は，球後組織に甲状腺と同じ抗原が存在し，TRAb,TSAbなどの自己抗体による免疫反応によって生じると考えられている．重症例では，血漿交換療法による原因となる抗体の除去が臨床的に有効と報告されている． | |
| Theme | Management of Systemic Diseases with Blood Purification : Aute and Chronic Stage of Diseases | |
|---|---|---|
| Title | Endocrine disease (thyrotoxic crisis etc.) | |
| Author | Yoshihiro Tominaga | Department of Sugery Renal Center and Blood Purification Center, Nagoya 2nd Red Cross Hospital |
| [ Summary ] | A thyrotoxic crisis is defined as a state of severe thyrotoxicosis with a high mortality rate, if adequate diagnosis and treatment can not be performed. Since turnover of thyroxin is low, it is difficult to rapidly suppress the synthesis of thyroxin and to reduce the serum level of the hormone with medication. Plasma pheresis is indicated for patients in very severe states, such as comma, severe heart failure, or shock, to rapidly remove both intravascular and extravasucular thyroxin. It has heen speculated that Grave's ophthalmopathy is induced by immunoreaction of auto-antibodies such as TSH receptor antibodies:TRAb, thyroid stimulating antibodies: TSAb and/or, thyroid stimulating blocking antibodies TSBAb, against the tissue surrounding the eye, in which same antigens existing in thyroid tissue are expressed. Plasma pheresis can remove theses auto-antibodies and is indicated for patients with severe ophthalmopathy. It has heen reported that plasma pheresis is clinically useful. |
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