摘要
Active ulcerative colitis （UC） is frequently associated with infiltration of a large number of leukocytes into the bowel mucosa. Therefore, removal of activated circulating leukocytes by apheresis has the potential for improving UC. In Japan, since April 2000, leukocytapheresis using Adacolumn has been approved as the treatment for active UC by the Ministry of Health and Welfare. The Adacolumn is an extracorporeal leukocyte apheresis device filled with cellulose acetate beads, and selectively adsorbs granulocytes and monocytes/macrophages. To assess the safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis （GMCAP） for UC, we reviewed 10 open trials of the use of GMCAP to treat UC. One apheresis session （session time, 60 min） per week for five consecutive weeks （a total of five apheresis sessions） has been a standard protocol. Several studies used modified protocols with two sessions per week, with 90-min session, or with a total of 10 apheresis sessions. Typical adverse reactions were dizziness, nausea, headache, flushing, and fever. No serious adverse effects were reported during and after GMCAP therapy, and almost all the patients could complete the treatment course. GMCAP is safe and well-tolerated. In the majority of patients, GMCAP therapy achieved clinical remission or improvement. GMCAP is a useful alternative therapy for patients with steroid-refractory or -dependent UC. GMCAP should have the potential to allow tapering the dose of steroids, and is useful for shortening the time to remission and avoiding re-administration of steroids at the time of relapse. Furthermore, GMCAP may have efficacy as the first-line therapy for steroid-naive patients or patients who have the first attack of UC. However, most of the previous studies were uncontrolled trials. To assess a definite efficacy of GMCAP, randomized, doubleblind, sham-controlled trials are necessary. A serious problem with GMCAP is cost; a single session costs ￥145 000 （$1 300）. However, if this treatment prevents hospital admission, re-administration of steroids and surgery, and improves a quality of life of the patients, GMCAP may prove to be cost-effective.
活跃 ulcerative (UC ) 经常与很多白血球的渗入被联系进肠粘膜。因此，由词首字母的脱落的激活的传播白血球的移动为改进 UC 有潜力。在日本，自从 2000 年 4 月，用 Adacolumn 的 leukocytapheresis 被卫生部和福利为活跃 UC 作为治疗同意了。Adacolumn 是充满乙酸纤维素祷告的一台身体外的白血球词首字母的脱落设备，并且有选择地吸附 granulocytes 和单核白血球 / 巨噬细胞。为 UC 估计安全和粒细胞和单核白血球 adsorptive 词首字母的脱落(GMCAP ) 的临床的功效，我们考察了 GMCAP 的使用的 10 开的试用对待 UC。一个词首字母的脱落会议(会议时间， 60 min ) 每为五个连续星期(五个词首字母的脱落会议的一个总数) 的星期是一个标准协议。几研究每星期与二个会议使用了修改协议，与 90-min 会议，或与 10 个词首字母的脱落会议的一个总数。典型不利反应是头昏，恶心，头疼，涌出，并且发烧。没有严肃的不利效果被报导在期间并且在 GMCAP 治疗以后，并且几乎所有病人能完成治疗功课。GMCAP 安全、容忍得好。在病人的多数， GMCAP 治疗完成了临床的宽恕或改进。GMCAP 是为有类固醇倔强或依赖的 UC 的病人的有用其他的治疗。GMCAP 应该有潜力允许逐渐变细类固醇的剂量，并且为弄短是有用的宽恕的时间和类固醇的避免的重新管理在恶化的时候。而且， GMCAP 可以为有 UC 的第一攻击的类固醇天真的病人或病人作为首要的治疗有功效。然而，大多数以前的研究是不受管束的试用。估计 GMCAP 的明确的功效，使随机化，双窗帘，假冒控制的试用是必要的。有 GMCAP 的一个严重问题被花费；一个单个会议花去 145 000 ($1 300 ) 。不管多么如果这治疗阻止医院承认，类固醇和手术的重新管理，并且改进病人，的生命的质量 GMCAP 可以证明划算。
