综述与专论：免疫吸附治疗自身免疫疾病的研究进展

自身免疫疾病治疗的常规方法 (如免疫抑制剂和血浆置换等)缺乏足够的安全性和有效性,因此,寻找新的治疗方法十分必要。免疫吸附(immunoadsorption,IA)是一种通过选择性或非选择性去除自身致病抗体,从而实现对自身免疫疾病治疗的方法。本文介绍了免疫吸附在扩张型心肌病、特发性膜性肾病、系统性红斑狼疮、重症肌无力4种自身免疫疾病中的研究和临床应用,讨论了该治疗方法的有效性和安全性;同时指出,免疫吸附要在更多的疾病中实现临床应用,还需要在可信度、地域性、样本量等方面做更加深入的临床前试验。

Review: Research Progress of Immunoadsorption in The Treatment of Autoimmune Diseases: a Review

Autoimmune disease refers to a kind of chronic systemic disease in which the body is mistakenly attacked by the immune system, causing damages to cells, tissues and organs. Studies show that the incidence of autoimmune diseases now accounts for 7%-9% of the global population, and is increasing year by year. Current methods for the treatment of autoimmune diseases (such as immunosuppressant and plasma exchange) lack sufficient safety and effectiveness. Therefore, it is necessary to develop new treatment methods. Immunoadsorption (IA) is a method of selective or nonselective removal of autopathogenic antibodies to achieve the therapeutic effect on autoimmune diseases. Immunosorbent therapy can effectively avoid various side effects such as fever, nausea and infection caused by current treatment, and quickly improve the degree of disease in a short time. At present, the vast majority of IA columns in clinical application are nonselective adsorption, which may deplete the whole immunoglobulin spectrum and lead to serious adverse reactions and autoantibody rebound. Selective immunoadsorption can specifically remove pathogenic antibodies without immunoglobulin replacement, and the adsorption efficiency is higher. Thus, selective immunoadsorption is a better treatment option, but long-term research shows that the development of its adsorbent is also more difficult. However, with the in-depth study of the pathological mechanism of autoimmune diseases and the rapid development of biomedical engineering, more and more potential targets of in vitro immunoadsorption have been identified, and the research of selective immunoadsorption has entered a stage of rapid development. This paper introduces the research and clinical application of immunoadsorption in four autoimmune diseases: dilated cardiomyopathy (DCM), idiopathic membranous nephropathy (IMN), systemic lupus erythematosus (SLE) and myasthenia gravis (MG), discusses the effectiveness and safety of this treatment method, and emphasizes the need to strengthen the study on the treatment of selective immunoadsorption to remove pathogenic antibodies. At the same time, it is pointed out that in order to realize the clinical application of immunoadsorption in more diseases, more in-depth preclinical trials need to be done in terms of reliability, regionality and sample size.