Treatment Of Moderate To Severe Ulcerative Colitis By Using Granulocyte And Monocyte Adsorption Apheresis(GMA) To Evaluate Its Efficacy And Safety–A Report Of 8 Cases

Objective: Ulcerative colitis(Ulcerative colitis,UC)is one of the phenotype of inflammatory bowel disease,which is chronic non-specific colitis.This kind of disease has seriously affected the people's life and work.It is more common in North America and Europe.However,in recent ten years in our country,this kind of disease is also showing a gradual increasing trend.Now UC has already become one of the common disease of digestive system diseases in China.Because the etiology is not well understood,the current aim of treatment is to induce and maintain clinical remission,reduce complications.Until now,the treatment of UC is still mainly based on drug therapy,including 5-amino salicylic acid,glucocorticoids,immunosuppressive agents and biological agents.Patients require life-long medications,and this can lead to drug dependency,loss of response together with adverse side effects.In order to avoid above issues happening,Japan first tries on non-pharmacologic therapy,namely cytapheresis(CAP),including leukocytapheresis(LACP)and granulocyte and monocyte adsorption apheresis(GMA),after years of large-scale clinical practice,it achieved good therapeutic effect.Therefore,this article aims to use GMA in the treatment of moderate to severe ulcerative colitis to observe its efficacy and safety.Methods: From September,2015 to February,2016,we collected 8 patients of moderate to severe ulcerative colitis in our department.The GMA treatment was performed twice a week.Among before GMA treatment,after 5 GMA sessions of treatment and 10 GMA sessions of treatment,the vital signs,clinical symptoms(abdominal pain,diarrhea,mucus and purulent stool,fever,parenteral symptom,etc.),laboratory tests(blood and stool routine,ESR,CRP,etc),and colonoscopy findings were recorded.Results: 8 patients of moderate to severe UC patients with GMA treatment,including 3 males and 5 females,who aged between 34-60 years old.The average age was 44.00 ± 11.00 years old.Mean course was 2.5 years.The ratio of moderate and severe was 3 to 5.Four patients completed 5 GMA sessions of treatment and three patients completed 10 GMA sessions of treatment.One patient didn't finish GMA sessions of treatment due to economic reasons.1.There was no significantly change in temperature,heartbeats and blood pressure before and after treatment.2.(1)The abdominal pain was improved or even disappeared except in one who underwent surgery.(2)The average frequency of diarrhea was 14.29 ± 9.34 times per day before treatment,while it was 3.57 ± 2.07 times per day after 5 GMA sessions of treatment.There was a significantly statistical difference in the frequency of diarrhea before and after treatment(p<0.05).The average frequency of diarrhea was 2.00 ± 1.73 times per day after 10 GMA sessions of treatment.(3)Mucous purulent stools were significantly relieved.A lot of pus cells,white blood cells and red blood cells were found in stool routine and occult blood was positive.They were significantly decreased after 5 GMA sessions of treatment,even disappeared after 10 GMA sessions of treatment.(4)4 patients had fever with temperature varied from 38.5? to 39.5?.While,the temperature was decreased(Tmax?38.5?)after 5 GMA sessions of treatment.Then,after 10 GMA sessions of treatment,the temperature returned to normal.(5)The average body weight was 65.14 ± 9.9 kg before treatment.It was 62.07 ± 9.7 kg after 5 GMA sessions of treatment.There was a significantly statistical difference in body weight before and after treatment(p<0.05).(6)2 patients had extraintestinal manifestations in whom the extraintestinal symtoms were not improved after 5 GMA sessions of treatment.3.The average ESR was 31.14 ± 24.17 mm / h before treatment.It was 20.00 ± 17.13 mm / h after 5 GMA sessions of treatment.There was no significantly statistical difference before and after treatment(p>0.05).The average ESR was 4.0 ± 2.0 mm / h after 10 GMA sessions of treatment.The average CRP was 51.29 ± 58.50 mg / L.It was 19.30 ± 18.24 mg / L after 5 GMA sessions of treatment.There was no significantly statistical difference before and after treatment(p>0.05).The average CRP was 4.27 ± 1.71 mg / L after 10 GMA sessions of treatment.Also,there was no significantly statistical difference in ALT,AST,ALB,T-Bil,Ccr,BUN,Glu,K+ and Ca2+ before and after treatment(p>0.05).4.The average Mayo score was 10.14 ± 1.46 points before treatment.According to Truelove&Witts Index,3 patients were moderate type,while 4 patients were severe type.After 5 GMA sessions of treatment,the ratio among mild,moderate and severe were 2 to 3 to 2.Also,the EI score of 3 patients was significantly decreased after 10 GMA sessions of treatment.One case was in clinical remission,while two cases were in clinical response.5.According to the self-efficacy evaluation scoring,5 out of 7 patients felt satisfied after using GMA sessions of treatment,especially in fourth or fifth GMA session of treatment.6.The symotoms of dizziness and chest tightness appeared during the first GMA treatment in one patient.Conclusion: GMA is a new,effective and safe non-pharmacologic therapeutic technique for patients with moderate to severe ulcerative colitis.It is worthwhile to recommend it for extensive clinical application for patients with ulcerative colitis.