血液浄化療法の使い方

Therapeutic Apheresis in Neurological Disorders

血液浄化療法はさまざまな領域の免疫介在性疾患における治療法の1つとして確立されてきた。その機序として，病原性を有する自己抗体や補体，サイトカインを血中から除去するとともに免疫調整作用が有効に働いていることが示唆されている。近年脳炎・脳症においても自己免疫機序の関与が多く報告されるようになったことをはじめ，血液浄化療法の適応が増加しつつある。本論では血液浄化療法と，適応となる神経疾患について概説する。

Abstract

Therapeutic apheresis is a valuable therapeutic option for various immune-mediated human disorders. Its therapeutic rationale is based on the removal of pathogenic autoantibodies and inflammatory molecules, such as complements, cytokines, and chemokines, that accelerate the disease activity. At the same time, other mechanisms of immune-modulatory effects have also been suggested. Therapeutic apheresis has been applied to Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, and multiple sclerosis. For neuromyelitis optica spectrum disorder (NMOSD), in which anti-aquaporin 4 antibody plays a major pathogenic role, both plasma exchange and plasma adsorption are reported to be effective. Recently, the incidence and prevalence of autoimmune encephalitis have been increasingly reported in comparison to infective encephalitis, and these often respond to therapeutic apheresis. Therapeutic apheresis for immune-mediated neurological disorders is described in this section.