中国血液净化

中国血液净化

• 临床研究 • 上一篇    下一篇

血浆置换在神经系统疾病中的应用

母艳蕾,张华   

  1. 卫生部北京医院神经内科
  • 出版日期:2012-12-12 发布日期:2013-01-04
  • 通讯作者: 张华 zhanghua@bjmoh.cn

Plasma exchange in the treatment of neurological diseases: analysis of 78 cases

  • Online:2012-12-12 Published:2013-01-04

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摘要： 【摘要】目的回顾分析血浆置换(plasma exchange，PE)治疗神经免疫性疾病患者的资料，了解其疗效和不良反应。方法 对78 例应用PE 换治疗过的患者资料回顾性分析，其中包括73例重症肌无力(myasthenia gravis, MG)，3例吉兰巴雷综合征(Guillain-Barre′syndrome, GBS)，1例慢性炎性脱髓鞘性多神经根神经病(chronic inflammatory demyelinating polyneuropathy, CIDP)和1 例多发性硬化(multiple sclerosis，MS)。PE头3 次为隔日1 次，之后为隔周1 次，偶有1周2次。应用临床评分观察疗效，根据临床记录了解有关副反应。结果 73例MG患者PE后第3d、第14d和第30d临床绝对评分明显降低，差异具有统计学意义。PE对3例GBS和1例CIDP患者疗效肯定，1例MS患者行双重置换(double filtration plasmapheresis,therapy, DFPP)后临床症状改善不明显，以上患者在PE治疗过程中未见严重不良反应。结论 PE在多数神经系统免疫疾病如MG、GBS和CIDP疗效肯定，不良反应较少。在治疗中枢神经系统脱髓鞘病(例如MS等)的情况有待进一步观察。

关键词: 血浆置换, 重症肌无力, 吉兰巴雷综合征, 慢性炎性脱髓鞘性多神经根神经病, 多发性硬化

Abstract: 【Abstract】 Objectives To assess the efficacy and side effects of plasma exchange (PE) in the treatment of myasthenia gravis (MG), Guillain-Barré syndrome (GBS), chronic inflammatory demyelination polyneuropathy (CIDP) and multiple sclerosis (MS) patients. Methods We retrospectively reviewed 78
neurological patients treated with PE, including MG 73 cases, GBS 3 cases, CIDP one case and MS one case. PE was performed every other day for 3 times, and then once a week (or twice a week for some patients). Efficacy was evaluated by clinical scales assessed before and after PE, and the side effects were recorded. Results In the 73 MG cases, the scores of absolute scale for clinical signs after PE for 3, 14 and 30 days were statistically lower than the score before PE. In the 3 GBS and one CIDP cases, PE was effective in shortening recovery period and improving disability. In the MS case, no prominent improvement was detected after double filtration plasmapheresis therapy. No serious side effects were found in these cases. Conclusion PE is an effective treatment for MG, GBS, and CIDP without serious side effects. However, PE for central nervous system demyelination diseases such as MS needs to be investigated in more patients.

Key words: Plasma exchange, Myasthenia gravis, Guillain-Barré, syndrome, Chronic inflammatory demyelination polyneuropathy, Double filtration plasmapheresis therapy, Multiple sclerosis