中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (12): 646-649.doi: 10.3969/j.issn.1671-4091.2012.12.003

• 临床研究 • 上一篇    下一篇

血浆净化治疗在风湿免疫性疾病中的应用

刘新宇,王晓红,李宾   

  1. 南方医科大学第三附属医院肾内科泌尿疾病研究所
  • 收稿日期:2012-07-23 出版日期:2012-12-12 发布日期:2012-12-12
  • 通讯作者: 邹和群 hequnzou@hotmail.com E-mail:18254736@qq.com

Application of plasma purification in rheumatism and immune diseases

  • Received:2012-07-23 Online:2012-12-12 Published:2012-12-12

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摘要： 【摘要】目的探讨血浆净化技术在风湿免疫性疾病治疗中的应用。方法 在南方医科大学第三附属医院血液净化中心行血浆净化治疗的风湿免疫性疾病患者63 例，在药物治疗的基础上，根据病情选择双重滤过血浆净化技术(double-filtration plasmapheresis, DFPP)或血浆吸附技术(plasma absorption,PA)治疗。治疗过程中密切观察生命体征及不良反应。治疗前后检测血清免疫球蛋白、自身抗体、补体(C3、C4)、红细胞沉降率(ESR)、C 反应蛋白(CRP)等指标，并观察治疗后的临床
反应。结果 16例系统性红斑狼疮患者在血浆净化治疗后SLEDAI评分、24h尿蛋白定量、抗ds-DNA 抗体、IgG、C3 均较治疗前显著改善，差异有统计学意义；10 例类风湿性关节炎患者血浆净化治疗后ESR、IgG 均较治疗前显著下降，其中8 例(80%)患者晨僵时间缩短，乏力症状改善。7 例(70%)患者关节肿胀和疼痛减轻。7 例强直性脊柱炎患者治疗后关节疼痛、晨僵方面均有不同程度的减轻，有效率1 0 0 %。在功能改善方面，有2 例患者改善2 个等级，4 例患者改善1 个等级，1 例患者无改善，有效率8 6%；5 例肌萎缩性脊髓侧索硬化症(“渐冻人”症)患者治疗后肌力均明显改善。单次DFPP 治疗后IgA、IgG、IgM、C3、C4 的下降率与单次PA 治疗后IgA、IgG、IgM、C3、C4 的下降率无显著的统计学差异。结论 血浆净化技术可有效治疗多种风湿免疫性疾病，且安全性高，临床上值得广泛开展。

关键词: 血浆置换, 双重滤过血浆净化, 血浆吸附, 风湿免疫性疾病

Abstract: 【Abstract】Objective To investigate the application of plasma purification in rheumatism and immune disease. Methods A total of 63 patients with rheumatism and immune diseases were treated with plasma purification in association with medications. Based on patient disease conditions, double-filtration plasmapheresis (DFPP) or plasma absorption (PA) was selected for the therapy. Vital signs and adverse reactions were carefully monitored during the plasma purification processes. Serum immunoglobulins, autoantibodies, complements, ESR, C reactive protein (CRP), and other indices were assayed before and after the treatment, and curative effect after the treatment was evaluated. Results In the 16 SLE cases after plasma purification, SLEDAI score, 24 h urinary protein, anti-ds-DNA antibody, IgG, and complement C3 improved significantly. In the 10 rheumatoid arthritis cases after the therapy, ESR and IgG decreased, morning stiffness and fatigue improved in 8 cases (80%), and joint swell and pain alleviated in 7 cases (70%). In the 7 ankylosing spondylitis
cases after the therapy, joint pain and morning stiffness relieved in all cases, and functional improvement achieved 2 grades in 2 cases and one grade in 4 cases with the overall effective rate of 86%. In 5 cases with amyotrophic lateral sclerosis after the therapy, muscle strength enhanced significantly. There were no significant differences in the clearance rate of IgA, IgG, IgM, C3 and C4 after single session of DFPP and PA. Conclusions Plasma purification can be effectively and safely used in various rheumatism immune diseases, and is worthwhile to be investigated in more patients.

Key words: Plasma exchange, Double-filtration plasmapheresis, Plasma absorption, Rheumatism immune disease