Research On The Application Of Immunoadsorption In The Treatment Of Neuroimmune Neurologic Diseases

Background Nervous system autoimmune disease refer to a main pathogenic mechanism on attacking are autoimmune diseases whose main pathogenic mechanism is to attack the nervous system by autoimmune cells and immune molecules.During the immune reaction,the pathogenic antibodies that act on the nervous system’s self-antigens are collectively called nervous system’s autoantibodies.With the continuous discovery of new autoantibodies,autoimmune diseases of the nervous system are constantly developing and recognizing,including autoimmune encephalitis,Guillain-Barré syndrome,myasthenia gravis,and optic neuromyelitis spectrum diseases.The treatment for autoimmune diseases of the nervous system includes corticosteroids,intravenous immunoglobulins,immunomodification drugs,immunosuppressants,and plasma exchange or immunoadsorption.Imumnoadsorption is a relatively new blood purification technique.It is a blood purification therapy that removes immunoglobulin through the specific binding of the active ligands of the separated plasma through a device.Its action mechanismmainly involves the following three aspects the rapid decrease of the concentration of antibodies and immune complexes in the blood,the redistribution of antibodies induced by the pulse,and the subsequent immunomodulatory effects.Mainly used in a variety of autoimmune diseases,including organ transplant(mainly for renal transplantation),kidney disease,(nephritis syndrome,systemic lupus erythematosus,etc.),and blood system diseases(hemophilia,immune thrombocytopenic purpura),nervous system diseases(mainly for the nervous system autoimmune disease)and endocrine,metabolic system diseases.At present,there are few clinical observation studies on immunoadsorption therapy in the treatment for autoimmune diseases of the nervous system in China.In view of the characteristics of rapid progress and high disability rate of autoimmune diseases of the nervous system,early and rapidly removing pathogenic autoimmune antibodies in early period can avoid extensive damage to nerve cells and reduce defects in nerve function.Early immunotherapy is associated with a good prognosis.Compared with traditional immunotherapy,immunoadsorption is more advantageous,but the efficacy of immunoadsorption in the treatment on autoimmune diseases of the nervous system still needs to be further study.Objectives Clinical symptoms,imaging and electrophysiological examination results,neurological functional status and changes in immunoglobulin levels of patients with immunological diseases of the nervous system before and after immunoadsorption were evaluated to evaluate the efficacy of immunoadsorption,so as to provide more options for the clinical treatment of autoimmune diseases of the nervous system.Methods 1.Research object A retrospective analysis of a total of 16 patients with neurological autoimmune diseases who were hospitalized in the Second Affiliated Hospital of Guangzhou Medical University from January 2019 to December 2019 was performed.There were 4 cases of optic neuromyelitis spectrum disease,10 cases of autoimmune encephalitis,1 case of guillain-barre syndrome,and 1 case of myasthenia gravis.All of them met the diagnostic criteria of related diseases,and all the corresponding autoimmune antibodies were detected in cerebrospinal fluid or serum tests.2.Treatment method 2.1 Immunosorbent All patients used protein A immunoadsorption technology and the Kang Bier protein A adsorption column produced by Guangzhou Kangsheng Biotechnology Co.,Ltd.for immunoadsorption,and all obtained the patient’s informed consent.2.2 Immunity therapy Among the 16 patients,15 were treated with glucocorticoid,among which 13 were treated with methylprednisolone 0.5g / d intravenous infusion therapy for 5 days,and the remaining 2 cases were 80 mg / d and 120 mg / d,respectively.Ten patients were co-administered with immunosuppressants,and all were treated with mycophenolate mofetil.Four patients were treated with immunoadsorption therapy after plasma replacement failed.3.Observation index Observed after adsorption of immunity of patients with clinical symptoms and signs of improvement,hospitalization duration,reaching the time needed for clinical improvement,auxiliary examination before and after the change,adsorption amount of renewable plasma treatment,before and after the adverse reactions occurred in the process of adsorption and adsorption in serum immunoglobulin G,immunoglobulin A,immunoglobulin M,complement C3,complement C4 and the changes of serum creatinine.The unified modified Rankin scale was used to evaluate the neurological function scores of patients,and the m RS scores before and after adsorption were recorded.The clinical effectiveness was defined as the m RS score reduced by at least 1 point after treatment.4.Statistical method All the results were analyzed and processed by SPSS 22.0.The measurement data of normal distribution are expressed as(x ? ± s)),while the measurement data of non-normal distribution are expressed as median M(quartile spacing IQR).The t-test was used to compare the quantitative data of the two samples,and the Wilcoxon symbolic rank test was used for the non-parametric test of the two paired samples.P<0.05 was considered statistically significant.Results Clinical data of all patients were recorded,and 13 of the 16 patients showed some improvement in their clinical symptoms.Among them,3 patients with autoimmune encephalitis showed significant improvement in consciousness disorders,mental symptoms and epileptic seizures.The reexamination results of 7 patients showed improvement after adsorption,including 1 patient with extensive multiple lesions of magnetic resonance skull and 1 patient with significantly improved electroencephalogram.The quantity of immunoglobulin G before immunoadsorption treatment was(17.87 ± 9.08)g / L,and the quantity of immunoglobulin G after immunoadsorption was(4.96 ± 3.56)g / L.And the comparison before and after immunoadsorption treatment is statistically significant(P = 0.001).However,immunoglobulin A and immunoglobulin M both decreased.Most of complement C3 and C4 decreased slightly after treatment,and some patients increased.But the comparison before and after immunoadsorption treatment was not statistically significant.In 13 of 16 patients,the m RS score before and after immunoadsorption improved by at least 1 point(range 1 to 4 points),and the remaining 3 patients had an m RS score of 5 points,which was the same as before adsorption,and no patients had increased scores.The median time between m RS scores before and after immunoadsorption was 30 days(IQR = 16).The median m RS score of all patients improved from 5.0 before immunoadsorption to 2.0 after immunoadsorption(P <0.001).Conclusion Immunoadsorption has a higher safety in the clinical observation of the treatment for autoimmune diseases of the nervous system,and the effect is significantly effective.It is reflected in the rapid relief of clinical symptoms.There is a significant improvement in the recovery of nerve function.