lymphoplasmapheresis LPE GBS CD8 + T CD4 + / CD8 + 2w Hughes

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Susan Lamb
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1 lymphoplasmapheresis LPE - Guillain-Barre syndrome GBS GBS 1w MRC 2w MRC Hughes 2w 90% CD8 + T CD4 + / CD8 + 2w Hughes 1 2w Hughes 1 LPE GBS GBS - R745 A Therapeutic effect of lymphoplasmapheresis in treatment of Guillain-Barre syndrome and its mechanism WANG Wei-fei LUO Meng-chuan LI Yuan et al. Department of Neurology Xiangya Hospital of Central South University Changsha China Abstract Objective To observe the therapeutic effect of lymphoplasmapheresis LPE in treatment of Guillain- Barre syndrome GBS and to explore its mechanism. Methods The change of neurological functions and the difference of the complete immunity blood routine conventional blood coagulation and lymphocyte subsets in peripheral blood before and after treatment with LPE were observed in GBS patients. Results After the treatment of LPE the MRC scores on one and two weeks was prominently improved as well as the Hughes scores and the effective rate reached 90%. The level of immunoglobulin complement the percentage of mononuclear cells and fibrinogen in blood was notably decreased after the treatment. After therapy percentage of CD8 + T lymphocyte was significantly increased and the ratio of CD4 + /CD8 + lymphocyte subset was decreased especially when the increase of Hughes scores was more than 1 in contrast to the opposite condition with little variation. Conclusion There was a significant effect in that LPE was used to treat GBS which probably by correcting the disorder of peripheral blood lymphocyte subsets and the direct removal of immunoglobulin complement mononuclear cells fibrinogen and other pathological substances. Key words Lymphoplasmapheresis Guillain-Barre syndrome Efficacy Lymphocyte subsets Immunoglobulin Complement The percentage of mononuclear cells Fibrinogen - Guillain-Barre syndrome GBS 1 lymphoplasmapheresis LPE GBS plasma exchange PE intravenous immunoglobulin IVIg 2 PE PE B PE T B yangh69@ yahoo. com

2 222 J Apoplexy and Nervous Diseases March 2012 Vol 29 No. 3 3 LPE GBS 0 ~ 5 0 ~ 60 GBS 1 2w Hughes Hughes wk Hughes 1 MRC 2 MRC 1 3 Hughes MRC 6 2 Hughes 2d 2005 IgG IgA IgM C3 C4 LPE GBS LPE GBS MRC Hughes 1. 4 χ ± s LPE GBS t P < ~ GBS Asbury 1990 GBS LPE 1w MRC t = P < w MRC Hughes ± t = t = P < w ± 1. 6d % ± 0. 8 / IgG IgA IgM COBE Spectra C3 C4 t = t = t = t = t = ml P < LPE manual t = t = P < LPE 4 LPE CD8 + T t = P < CD4 + / CD8 + t = P < CD3 + T CD4 + T 1. 3 CD19 + B 1 2w Hughes 1 A 1d 1w 2w 1 2w Hughes 1 B Hughes 0 1 A CD8 + T 2 t = P < CD4 + / CD t = P < B 6 2MRC

3 LPE χ ± s 1d 1w 2w Hughes 3. 7 ± ± ± ± * MRC ± ± ± * ± * LPE g /L χ ± s IgG IgA IgM C3 C ± ± ± ± ± ± * ± * ± * ± * ± * 3 LPE χ ± s % g /L ± ± ± * ± * 4 LPE % χ ± s CD3 + CD4 + CD8 + CD4 + / CD8 + CD ± ± ± ± ± ± ± ± * ± * ± A ± ± ± ± ± ± ± ± * ± * ± B ± ± ± ± ± ± ± ± ± ± GBS acute inflammatory demyelinating polyneuropathies AIDP 2w AMAN AMSAN Miller Fisher Miller Fisher syndrome MFS 5 4 GBS

4 224 J Apoplexy and Nervous Diseases March 2012 Vol 29 No. 3 LPE AIDP T LPE GBS IgG TNF-α IFN-γ IL-2 IgA IgM C3 C4 LPE NO B 6 AMAN AMSAN GM GM 1 a GM 1 b Ga1Nac-GD1a 9 80% ~ 90% MFS GQ1b 7 T B GBS Hu 10 IL-23 T IL-23 LPE 8 T B LPE GBS B IgG 8 Yuki EPK1 /2 2d P75NTR 2 40% ~ 60% LPE 12 % 13 T B LPE GBS LPE LPE LPE GBS GBS GBS T CD4 + T 50% 1d CD8 + CD4 + / CD8 + 1w MRC 2w MRC Hughes 90% GBS GBS T CD4 + 2w / T CD4 + CD29 + / T CD4 + CD45RA + /

5 Yu RK. Antiglycolipid antibodies in Guillain-Barre syndrome and related diseases review of clinical features and antibody specifici- T CD CD8 + CD4 + B 1 Ariga T B CD8 + CD4 + / CD8 + ties J. J Neurosci Res Hughes RA Swan AV Raphael JC B Barre syndrome a systematic review J. Brain GBS CD3 + CD4 + CD8 + CD19 + LPE Barre syndrome J LPE GBS CD8 + T J CD4 + / CD8 + 2w Hughes 1 Yuki N. Peripheral neuropathies and anti-glycolipid anti- 2w Hughes 1 J LPE 6 Kieseier BC CD8 + T 7 Willison HJ B bodies J LPE CD4 + CD19 + CD19 + CD4 + GBS LPE LPE GBS 1 LPE GBS 4 10 Hu W ~ 8d LPE 2 LPE 1 3 ~ 5d 4 3 GBS LPE 1 12 Akassoglou K 2 IgM 3 Neuron Sanjay R LPE 4 Barre syndrome J 14 Harness J GBS GBS Pritchard J Makowska A Gregson NA CD4 + CD25 + Neuroimmunol LPE et al. Immunotherapy for Guillain Pt 9 3 Li BJ Yang XS Peng JJ et al. Lymphoplasmapheresis for Guillain-. Zhong Nan Da Xue Xue Bao Yi Xue Ban Lehmann HC Hartung HP. Plasma exchange and intravenous immunoglobulins mechanism of action in immune-mediated neuropathies. J Neuroimmunol Hartung HP Wiendl H. Immune circuitry in the peripheral nervous system J. Curr Opin Neurol Brain Pt Lehmann HC Hartung HP Hetzel GR et al. Plasma exchange in neuroimmunological disorders Part 1 Rationale and treatment of inflammatory central nervous system disorders J. Arch Neurol Gaudet AD Popovich PG Ramer MS. Wallerian degeneration gaining perspective on inflammatory events after peripheral nerve injury J. J Neuroinflammation Dehmel T Pirhonen J et al. Interleukin 23 in acute inflammatory demyelination of the peripheral nerve J. Arch Neurol Liu X Piela-Smith TH. Fibrin ogen -induced expression of ICAM-1 and chemokines in human synovial fibroblasts J. J Immunol Yu WM Akpinar P et al. Fibrin inhibits peripheral nerve remyelination by regulating Schwann cell differentiation J Flanagan J Sodano D et al. The acute phase reactant fibrinogen as a guide to plasma exchange therapy for acute Guillain-. J Clin Apher Mccombe PA. Increased levels of activated T-cells and reduced levels of CD4 /CD25 + cells in peripheral blood of Guillain- Barre syndrome patients compared to controls J. J Clin Neurosci et al. Reduced circulating cell populations in Guillain-Barre syndrome J. J

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