Data Sheet 1_Intermittent immunoadsorption in critically ill patients with neuroimmunological disorders: a retrospective study.pdf

ObjectivesThis study aimed to evaluate the efficacy and safety of intermittent immunoadsorption (IA) in critically ill patients with refractory autoimmune neurological disorders.
MethodsWe retrospectively reviewed 13 patients admitted to the neurocritical care unit with severe autoimmune encephalitis, Guillain–Barré syndrome, neuromyelitis optica spectrum disorders, or chronic inflammatory demyelinating polyneuropathy, all of whom had failed first-line immunotherapy (intravenous methylprednisolone and/or intravenous immunoglobulin). IA was administered intermittently, with schedules individualized based on clinical status.
ResultsThe modified Rankin Scale (mRS) improved significantly following IA (p = 0.02), while the Acute Physiology and Chronic Health Evaluation II scores (APACHE II) remained stable (p = 0.95). Serum IgG levels declined by a median of 55.6%. Pathogenic antibody negativity was achieved in 65% of plasma and 38% of cerebrospinal fluid samples. Although 92% experienced treatment interruptions (e.g., infection and hypotension), IA was generally well tolerated and not permanently discontinued.
DiscussionThis study supports the feasibility and clinical utility of intermittent IA in critically ill patients with treatment-refractory neuroimmunological disorders. Despite frequent complications, flexible scheduling allowed continued therapy with sustained benefit. These findings highlight a potentially adaptable treatment strategy in a population often excluded from therapeutic interventions and suggest that IA warrants further study in neurocritical care settings.

研究目的
本研究旨在评估间歇性免疫吸附（immunoadsorption, IA）治疗难治性自身免疫性神经系统疾病重症患者的有效性与安全性。
研究方法
我们回顾性分析了13例收入神经重症监护病房的患者，其均患有重症自身免疫性脑炎、吉兰-巴雷综合征、视神经脊髓炎谱系疾病或慢性炎症性脱髓鞘性多发性神经病，且一线免疫治疗（静脉用甲泼尼龙和/或静脉用免疫球蛋白）均失败。我们根据患者临床状态个体化制定间歇性免疫吸附（IA）治疗方案并实施。
研究结果
间歇性免疫吸附（IA）治疗后，改良Rankin量表（modified Rankin Scale, mRS）评分显著改善（p=0.02），而急性生理学与慢性健康状况评分系统Ⅱ（Acute Physiology and Chronic Health Evaluation II, APACHE II）评分保持稳定（p=0.95）。血清IgG水平较基线中位数下降55.6%。65%的血浆样本与38%的脑脊液样本可检出致病性抗体转阴。尽管92%的患者出现治疗中断情况（如感染、低血压），但IA整体耐受性良好，未出现永久终止治疗的情况。
讨论
本研究证实了间歇性免疫吸附（IA）在治疗难治性神经免疫性疾病重症患者中的可行性与临床应用价值。尽管治疗相关并发症较为常见，但灵活的治疗方案可使患者持续接受治疗并获得持续获益。本研究结果为这类常被排除在治疗干预之外的患者群体提供了一种潜在的个体化治疗策略，并提示在神经重症监护场景中，免疫吸附（IA）值得开展进一步研究。