臨牀透析 Vol.27 No.12(7)


特集名 アフェレシスUpdate ― 各科領域における進歩と展望
題名 皮膚科疾患に対するアフェレシス療法
発刊年月 2011年 11月
著者 山田 裕道 国際親善総合病院皮膚科
著者 高森 建二 順天堂大学医学部付属浦安病院
【 要旨 】 皮膚科領域のApheresis updateとして中毒性表皮壊死症（toxic epidermal necrolysis；TEN）に対する血漿交換療法と壊疽性膿皮症，膿疱性乾癬に対する顆粒球除去療法（granulocytapheresis；GCAP）および白血球除去療法（leukocytapheresis；LCAP）を取り上げた．TENに対する血漿交換療法は，1988年の第1例施行以来75例の報告がある．有効率は86.7％であり，死亡率は13.3％と低かった．壊疽性膿皮症では現在までGCAP施行例20例，LCAP施行例12例が報告されており，有効率はそれぞれ90％，100％で，どちらも優れていた．膿疱性乾癬ではGCAP，LCAP合わせて22例に施行され，有効率59.1％であった．
Theme Apheresis Update
Title Apheresis for treatment of skin diseases
Author Hiromichi Yamada Department of Dermatology, International Goodwill Hospital
Author Kenji Takamori Juntendo University Urayasu Hospital
[ Summary ] Toxic epidermal necrolysis (TEN) treated with plasma exchange (PEX), pyoderma gangrenosum and pustular psoriasis treated with granulocytapheresis (GCAP) or leukocytapheresis (LCAP) are described. Seventy five TEN patients were treated with PEX. The efficacy of PEX for the treatment of TEN was as follows : excellent in 44 cases, good in 21 cases, fair in 3 cases, no effect in 6 cases. The rate of effectiveness was 86.7 % and the mortality rate was 17.3 %. PEX was found to be an effective treatment for TEN.
Thirty two pyoderma gangrenosum patients were treated with GCAP or LCAP. The efficacy of GCAP/LCAP for the treatment of pyoderma gangrenosum was as follows : excellent in 8 cases, good in 22 cases, fair in 2 cases, no effect in 0 cases. The rate of effectiveness was 93.8 %. GCAP/LCAP were found to be effective treatments for pyoderma gangrenosum. Twenty two pustular psoriasis patients were treated with GCAP or LCAP. The efficacy of GCAP/LCAP for the treatment of pustular psoriasis was as follows：excellent in 3 cases, good in 10 cases, fair in 5 cases, no effect in 4 cases. The rate of effectiveness was 59.1 %.
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