難治性潰瘍性大腸炎治療としての白血球除去療法

Leukocytapheresis as an Alternative Therapy for Refractory Ulcerative Colitis Patients

要旨　遠心分離式細胞分離装置，顆粒球除去カラム，白血球除去フィルターを用いた白血球除去療法は，本邦における臨床試験を経て，主にステロイド抵抗性の潰瘍性大腸炎のalternative therapyとして確立され，治療指針に組み入れられるに至った．いずれの方法を用いても，60～70％の症例に対して臨床症状や内視鏡所見の改善が期待できる．施行に伴う副作用は少なく，出現しても軽微で一過性であるが，体外循環について習熟した施設で行われるべきである．また，本法による改善効果の発現が比較的緩徐であることから，大出血や穿孔の危険のある症例では，その適応に際しては注意を要する．

　Leukocytapheresis, using a centrifugal cell separator, or a granulocyte-absorbing column, or a leukocyte-trapping filter were methods developed in Japan as alternative therapies for steroid-resistant cases of ulcerative colitis (UC). According to the results of clinical trials performed by institutes throughout the country, the therapeutic efficacy of leukocytapheresis using these apparatuses was demonstrated in 59～73 ％ of UC patients resistant to conventional steroid administration. Adverse events during extracorporeal circulation were found in 5～20 ％ of cases, but most of the symptoms were temporary. Improvement of symptoms of UC during leukocytapheresis is relatively slow and often requires 3～5 repetitions of the procedure, the ideal indication for leukocytpheresis is a moderately active case without impending complications.