中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (02): 91-94.doi: 10.3969/j.issn.1671-4091.2016.02.008

• 临床研究 • 上一篇    下一篇

血液灌流治疗系统性硬化症的疗效观察

钮含春,李晓云,刘亮,霍泉金,靳晓晴   

  1. 石家庄平安医院风湿免疫科
  • 收稿日期:2015-07-06 修回日期:2016-01-02 出版日期:2016-02-12 发布日期:2016-02-19
  • 通讯作者: 钮含春 niuhanchun@163.com E-mail:niuhanchun@163.com

Effect of Hemoperfusion in the Treatment of Systemic Sclerosis

  • Received:2015-07-06 Revised:2016-01-02 Online:2016-02-12 Published:2016-02-19

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摘要： 目的观察血液灌流治疗系统性硬化症(systemic sclerosis，SSc)的临床疗效。方法 选取2014 年2 月至2014 年8 月期间在我院住院治疗的36 例SSc 水肿期及硬化期的初治患者，按随机数字表法分为血液灌流组(19 例)和常规治疗组(17 例)。常规治疗组给予泼尼松5～15mg/日、青霉胺0.25～0.5g/日及活血化瘀类中药；血液灌流组在常规治疗基础上加用血液灌流治疗，每次血液灌流治疗时间2～3h,1 次/周，共4 次。比较2 组治疗前后所测定的红细胞沉降率(erythrocyte sedimentation rate，ESR)、免疫球蛋白G(immunoglobulin G，IgG)、免疫球蛋白M(immunoglobulin M，IgM)、免疫球蛋白A(immunoglobulinA，IgA)、全血粘度(whole-blood viscosity，BV)、血浆粘度(plasma viscosity，PV)、红细胞聚集指数红细胞聚集指数(index of erythrocyte aggregation，IEA)；比较2 组治疗前后评定的改良的Rodnan 皮肤厚度积分、Furst’s 内脏评分。结果血液灌流组治疗后皮肤Rodnan 修订积分明显低于本组治疗前(t=5.724,P=0.000)及常规治疗组治疗后(t=2.751, P= 0.010)，Furst’s 内脏评分明显低于本组治疗前(t=3.874,P=0.000)及常规治疗组治疗后(t=2.962,P=0.006)。血液灌流组治疗后ESR 明显低于本组治疗前(t=3.788, P= 0.000)及常规治疗组治疗后(t=2.663,P=0.012)，IgG 明显低于本组治疗前(t=3.799,P=0.000)及常规治疗组治疗后(t=2.088,P=0.044)，BV 明显低于本组治疗前(t= 15.674,P=0.000)及常规治疗组治疗后(t=6.317,P=0.000)，PV 低于本组治疗前(t=24.179,P=0.000)及常规治疗组治疗后(t=13.091,P=0.000)，IEA 明显低于本组治疗前(t=9.507,P=0.000)及常规治疗组治疗后(t=3.392,P=0.002)；而血液灌流组治疗前后比较血IgM(t=0.205,P=0.839)、IgA(t=0.473,P=0.639)差异无统计学意义。结论血液灌流可更好的改善SSc患者的临床状况，改善实验室检查指标。

关键词: 血液灌流, 系统性硬化症, 免疫吸附, 治疗结果

Abstract: Objective To investigate the clinical effect of hemoperfusion in treating patients with systemic sclerosis (SSc). Methods A total of 36 patients with SSc at the stage of swelling or sclerosis in our hospital during Feb. 2014 to Jun. 2014 were enrolled in this study. They were randomly divided into two groups: hemoperfusion group (n=19) and conventional group (n=17). The patients in conventional group were treated with prednisone 5～15mg/day, penicillamine 0.25～0.5g/day, and the traditional Chinese medicine of blood circulation activation. The patients in hemoperfusion group were treated with hemoperfusion 2~3 hours, once a week for 4 weeks, in addition to the medications in conventional group. Laboratory indexes including erythrocyte sedimentation rate (ESR), immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), whole-blood viscosity (BV), plasma viscosity (PV) and index of erythrocyte aggregation (IEA) were compared before and after the treatment in the two groups. Moreover, modified Rodnan skin score and Furst’s internal organs score were also compared between the 2 groups. Results In hemoperfusion group, modified Rodnan skin score, Furst’s internal organs score, ESR, IgG, BV, PV and IEA were lower than the scores before the treatment, as well as the scores after the treatment in conventional group (P＜0.05). However, IgM value was statistically indifferent before and after the treatment in hemoperfusion group. Conclusions Hemoperfusion can improve clinical symptoms and laboratory indexes in patients with SSc.

Key words: Hemoperfusion, Systemic sclerosis, Immunoadsorption, Treatment outcome