| Objectives:Ulcerative colitis(UC)is a chronic recurrent disease of gastrointestinal tract.It is often accompanied by local or systemic complications,which may seriously damage the quality of life and affect the life expectancy.Nowadays,the main clinical treatments include 5-amino salicylic acid,steroids,immunosuppressive agents,biologi-cal agents,nutritional support and surgical treatment.However,there are some limita-tions in efficacy and safety.Studies have shown that a large number of inflammatory cytokines produced by neutrophils and mononuclear cells through infiltrating the intestinal mucosa are considered to be key factors for the pathogenesis of UC.Granulo-cyte and monocyte adsorption apheresis(GMA)has been used as a non-drug therapeutic strategy in Japan and Europe to reduce the inflammatory response in patients with ac-tive UC,however,it has not yet been extensively used clinically in China.Therefore,the objective of this study was to investigate the short-term clinical efficacy and safety of GMA in the treatment of active UC,and to provide a new plan for UC.Methods:Totally,27 active UC patients in the Digestive Department of the First Affiliated Hospital of Dalian Medical University from September 2015 to February 2018 who received GMA were enrolled in this study.The Mayo score,laboratory indexes[hemoglobin(HB),white blood cell count(WBC),neutrophil count,mononuclear cell count,lymphocyte count,platelet count,ESR,CRP],Rachmilewitz e-ndoscopic index(EI)and adverse reactions were analyzed before and after the t-reatment,respectively.Spss 23.0 software was used for the statistical analysis,P<0.05 was considered to be of statistical significance.Results:1.General data:Among the included 27 active UC patients,each patient received 5 to 10 sessions of the GMA treatment with 2 sessions a week.There were 15 male patients and 12 female patients,the average age of whom was 42.14±8.92 years(30-76years)and the average course of disease was 43.10±33.49m(0.67-96m).Among them,4(15%)patients were in the mild active stage,18(67%)p-atients were in the moderate active stage and 5(18%)patients were in the severe active stage.Moreover,the lesion range of 2(7%),8(30%)and 17(63%)patients w-as E1,E2 and E3,respectively.2.Laboratory indexes:2.1 Comparison of blood routine before and after the treatment:The white blood cell count was 6.81±1.5×10~9/L before the treatment and 5.89±1.45×10~9/L after the treatment(P<0.001).At the same time,the neutrophil co-unt was 0.67±0.31×10~9/L and 0.49±0.18×10~9/L before and after the treatment(P=0.001),respectively.The platelet count was 306.85±128.94×10~9/L before the treatme-nt and 266.33±100.82×10~9/L after the treatment(P=0.002).The hemoglobin was 122.33±23.97 g/L before the treatment and 118.15±20.61 g/L after the treatment(P=0.032).The above indexes were statistically significantly lower after the treatment(p<0.05).The lymphocyte count was 1.81±0.63×10~9/L before the treatment and1.99±0.78×10~9/L after the treatment.However,no statistically significance was fou-nd in this index(P>0.05).2.2 Comparison of inflammatory factors before and after the treatment:The ESR was 21.77±17.08 mm/h before the treatment and 19.54±20.44 mm/h after the treatment(P>0.05),However,no statistically significance was found in this index.The CRP was 20.21±33.5 mg/L before the treatment and 8.4±12.37 mg/L after the treat-ment,which was significantly lower after the treatment(P=0.038).3.Evaluation of the clinical efficacy:The Mayo score of the 27 patients was 8.11±1.72 before the treatment and3.04±1.22 scores after the treatment,which was significantly lower after the treatment(P<0.001).The Rachmilewitz endoscopic index of the 27 patients was 4.67±2.8 points before the treatment and 2.7±1.17 scores after the treatment,The above indexes were statistically significantly lower after the treatment(P=0.002).8(30%)patients were remission,16(59%)patients were effective,and 3(11%)patients were ineffective.The total effective rate was 89%.The complete mucosal healing rate was 30%(8/27),mucosal partial healing rate was 41%(11/27),total mucosal healing rate was 71%(19/27),and the endoscopy remission rate was 93%(25/27).4.During the treatment of GMA,1 patient experienced chest tightness and 1 pa-tient experienced chest pain,which were both relieved in a short period of time.5.Conclusion:GMA therapy could effectively and safely improve the clinical symptoms and intestinal mucosa damage in patients with active UC,and control the inflammatory activity. |
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