Faktori koji utiču na efikasnost/produktivnost terapijske izmene plazme u lečenju imunski posredovanih neuroloških poremećaja – pilot studija

  • Marija Vraneš University Clinical Center Kragujevac, Blood Bank Department, Kragujevac, Serbia
  • Aleksandar Lazović University Clinical Center Kragujevac, Department of Surgery, Kragujevac, Serbi
  • Bela Balint ‡Serbian Academy of Sciences and Arts, Department of Medical Sciences; §University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Vladimir Jakovljević University of Kragujevac, Faculty of Medical Sciences, Department of Physiology, Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Kragujevac, Serbia; University IM Sechenov, 1st Moscow State Medical, Department of Human Pathology, Moscow, Russia
  • Milena Todorović Balint University Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Tatjana Bošković Matić University of Kragujevac, Faculty of Medical Sciences, Department of Neurology Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP241022030V
Ključne reči: afereza;, poliradikuloneuritis;, plazmafereza;, miastenija gravis;, multipla skleroza;, lečenje, ishod

Sažetak


Uvod/Cilj. Standardno lečenje za imunski posredovane neurološke poremećaje (IPNP) uključuje upotrebu imunosupresivnih lekova i drugih terapija. Terapijska izmena plazme (TIP) je efikasan dopunski imunomodulacijski pristup. Njen osnovni cilj je smanjenje „opterećenja“ bolesnika patogenim faktorima (uključujući autoantitela) na nivoe koji će omogućiti kliničko poboljšanje. Imunosupresivni lekovi, korišćeni istovremeno sa TIP, smanjuju „povratni porast“ sinteze autoantitela. Cilj rada bio je da se proceni efikasnost protokola naše standardizovane TIP i utvrdi korelacija ishoda TIP tretmana sa parakliničkim (laboratorijskim) i afereznim parametrima/podacima. Metode. Istraživanjem su obuhvaćena 32 bolesnika sa miastenijom gravis, sindromom Guillain-Barré ili akutnom poliradikuloneuropatijom i multiplom sklerozom. TIP je izvođena korišćenjem aparata Spectra-Optia® (Terumo-BCT, SAD). Svojstva našeg afereznog protokola primenjenog kod bolesnika sa IPNP bila su: a) sveukupni tretman – pet pojedinačnih TIP procedura; b) učestalost TIP – svaki drugi dan; c) uklonjena plazma – jedan volumen cirkulišuće plazme bolesnika (opseg 2 800–3 100 mL). Efikasnost TIP procenjena je na osnovu oporavka neurološkog deficita i provodljivosti perifernih nerava, pozitivnih nalaza u para-kliničkim (laboratorijskim) testovima i praćenja afereznih parametara. Rezultati. Korišćenjem opisanog protokola afereze primećen je jasan pozitivan terapijski efekat kod bolesnika koji su bili podvrgnuti TIP procedurama bez prekida. Procedure TIP bile su korisne kod 84,4% bolesnika (stopa efektivnosti 89,3%; stopa izostanka odgovora 10,7%), dok kod 15,6% slučajeva tretman nije završen zbog infekcije bolesnika teškim akutnim respiratornim sindromom koronavirusa 2 (severe acute respiratory syndrome coronavirus 2 – SARS-CoV-2) (praćene koronavirusnom bolešću 19 – COVID-19). Bolesnici kod kojih je sprovedeno pet pojedinačnih TIP imali su evidentno kliničko poboljšanje u smislu skale invaliditeta, slabosti mišića ili deficita neuronske provodljivosti. U periodu praćenja nisu zabeleženi recidivi. Značajno smanjene vrednosti eritrocitnih parametara (posebno nivoa hematokrita) bili su u korelaciji sa većom efikasnošću TIP, zahvaljujući povišenom odnosu volumena plazme/krvnih ćelija, što je bilo praćeno većom efikasnošću prikupljanja/uklanjanja plazme. Ostali praćeni laboratorijski nalazi nisu pokazali pozitivnu korelaciju sa efikasnošću/produktivnošću TIP. Nije bilo teških neželjenih događaja. Nije bilo realpsa u narednih 6 meseci. Zaključak. U ovom istraživanju značajno smanjene vrednosti eritrocitnih parametara (posebno nivoa hematokrita) bili su u korelaciji sa većom efikasnošću TIP. Za definitivne zaključke potrebne su buduće randomizovane i veće kliničke studije.

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2025/05/29
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Vol. 82 Br. 05 (2025): Vojnosanitetski pregled
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