重复免疫吸附对covid后肌痛性脑脊髓炎/慢性疲劳综合征患者β2-肾上腺素能受体自身抗体升高的疗效：一项前瞻性队列研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-02-01 DOI:10.1016/j.lanepe.2024.101161

Elisa Stein , Cornelia Heindrich , Kirsten Wittke , Claudia Kedor , Rebekka Rust , Helma Freitag , Franziska Sotzny , Anne Krüger , Markus Tölle , Patricia Grabowski , Carmen Scheibenbogen , Laura Kim

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引用次数: 0

摘要

背景：自大流行以来，严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）已成为肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）的主要诱因。有证据表明，自身免疫起着重要的病理生理作用。我们旨在评估IA治疗covid后ME/CFS患者的有效性。方法：本研究纳入了2022年10月至2023年10月期间发现β2肾上腺素能自身抗体（β2 AR-AB）升高的20例2019冠状病毒病（COVID）后ME/CFS患者。中位病程为22个月（IQR: 15-31）的患者在德国柏林的charit - Universitätsmedizin接受了5次免疫吸附治疗。男性7例，女性13例，中位年龄40岁（IQR: 36-51）。主要终点是从基线到免疫吸附后四周的健康调查身体功能域（sf36pf）的变化。主要症状通过六个月的问卷调查进行评估。握力和EndoPAT®测量用于评估肌肉疲劳和血管功能障碍。在初次反应后病情恶化的7名患者接受了第二周期治疗。结果：治疗总体耐受良好，总免疫球蛋白G降低79% (CI: 73-84%)， β2 AR-AB降低77% （CI: 58-95%）。患者表现出SF36 PF平均增加17.75点（CI: 13.41-26.16），最大的改善发生在第2和第3个月之间，并在第6个月保持显著的增长。14/20（70%）的患者被归类为sf36pf升高≥10分的应答者。据报道，在疲劳、运动后不适、疼痛、认知、自主神经和免疫症状方面有进一步的持久改善。女性患者在第6个月时重复握力增加。解释：免疫吸附可能改善covid - 19后ME/CFS患者的症状。IgG耗竭的有益作用表明，自身抗体和紊乱的b细胞功能在这种疾病的病理生理中起着重要作用。资助：由联邦教育和研究部和Weidenhammer Zöbele研究基金会资助。

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Efficacy of repeated immunoadsorption in patients with post-COVID myalgic encephalomyelitis/chronic fatigue syndrome and elevated β2-adrenergic receptor autoantibodies: a prospective cohort study

Background

Since the pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the leading trigger for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Evidence indicates that autoimmunity plays an important pathophysiological role. We aimed to evaluate the effectiveness of IA treatment in post-COVID ME/CFS patients.

Methods

This pre-post study included 20 post-coronavirus disease 2019 (COVID) ME/CFS patients found to have elevated β2 adrenergic autoantibodies (β2 AR-AB) between October 2022 and October 2023. Patients, with a median disease duration of 22 months (IQR: 15–31), were treated with five immunoadsorption sessions at Charité - Universitätsmedizin Berlin, Germany. Seven were male and 13 female, with a median age of 40 years (IQR: 36–51). The primary end point was the change in the Short Form (36) Health Survey physical functioning domain (SF36 PF) from baseline to four weeks post immunoadsorption. Key symptoms were assessed via questionnaires over six months. Handgrip strength and EndoPAT® measurements were used to evaluate muscle fatigue and vascular dysfunction. Seven patients who worsened after an initial response received a second cycle.

Findings

The treatment was generally well tolerated, reducing total immunoglobulin G by 79% (CI: 73–84%) and β2 AR-AB by 77% (CI: 58–95%). Patients demonstrated a mean increase in the SF36 PF of 17.75 points (CI: 13.41–26.16), with the greatest improvement occurring between months two and three, and significant gains maintained through month six. 14/20 (70%) patients were categorized as responders with an increase in the SF36 PF of ≥ ten points. Further lasting improvements were reported in fatigue, post-exertional malaise, pain, cognitive, autonomic, and immunological symptoms. Female patients had increased repeat handgrip strength at month six.

Interpretation

Immunoadsorption may improve symptoms in post-COVID ME/CFS patients. The beneficial effects of IgG depletion suggest a significant role for autoantibodies and disturbed B-cell function in the condition's pathophysiology.

Funding

Funded by The Federal Ministry of Education and Research and the Weidenhammer Zöbele Research Foundation.

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.