双重血浆置换清除抗肾小球基底膜抗体效果研究

›› 2009, Vol. 8 ›› Issue (3): 147-151.

双重血浆置换清除抗肾小球基底膜抗体效果研究

程叙扬金其庄毛微波鲍云飞于重燕左力

北京大学第一医院肾内科暨肾脏病研究所

收稿日期:2009-01-25 修回日期:1900-01-01 出版日期:2009-03-12 发布日期:2009-03-12

Clearance of anti-glomerular basement membrane (GBM) antibodies and immunoglobulin by double-filtration plasmapheresis in patients with anti-GBM disease

CHENG Xu-yang, JIN Qi-zhuang, MAO Wei-bo, BAO Yun-fei, YU Chong-yan, ZUO Li

Division of Nephrology, Institute of Nephrology, Peking University First Hospital, Beijing 100034, China

Received:2009-01-25 Revised:1900-01-01 Online:2009-03-12 Published:2009-03-12

摘要/Abstract

摘要： 【摘要】目的与单纯血浆置换相比，双重血浆置换(DFPP)仅需少量血浆或白蛋白即可实现对致病抗体的清除。但DFPP用于清除抗肾小球基底膜(GBM)抗体的效率和安全性尚不明确。方法入选我科2008年收治并接受DFPP治疗的抗GBM病的全部患者，共8例。所有患者接受免疫抑制治疗，同时进行每日或隔日一次DFPP，收集每次治疗前后的血样。用ELISA法检测DFPP前后的抗GBM抗体浓度，同时检测血IgG、白蛋白和纤维蛋白原(FIB)水平。结果共进行53例次DFPP，每人最少治疗4次，最多9次。每次使用白蛋白或血浆量为(1.26±0.14)倍的人体血浆体积，使用OP-08W血浆分离器和EC- 20W或30W血浆成分分离器。患者治疗前平均抗GBM浓度为(159.94±67.02)RU/ml，DFPP治疗后抗体呈线性下降(r = 0.88-0.995)，不同患者抗GBM抗体浓度下降斜率相似(-16.3RU/ml/次至 -29.9 RU/ml/次)，平均斜率 (-20.27次。用新鲜冰冻血浆作为置换液治疗后患者血白蛋白水平显著下降，用8%白蛋白溶液置换对白蛋白没有影响。每次DFPP治疗后IgG水平和FIB水平均显著下降。IgG呈指数下降，而每次治疗后FIB下降(49.5±8.9)%。结论 DFPP可以有效地清除抗GBM抗体和IgG。抗GBM浓度呈线性下降，有助于医生在治疗前估计清除抗体需要的DFPP次数。用高浓度白蛋白作为置换液可以避免血白蛋白下降。DFPP对纤维蛋白原也有很大清除，应该注意出血合并症。

关键词: 血浆置换, 双重血浆置换, 抗肾小球基底膜抗体, 抗肾小球基底膜病

Abstract: 【Abstract】 Objective Compared with plasma exchange, double-filtration plasmapheresis (DFPP) needs only small amount of plasma or albumin. But the efficiency and safety of DFPP in treating anti-GBM disease was unclear. Patients and methods There were 8 patients admitted to this hospital in 2008 with the diagnosis of anti-GBM disease confirmed by serological and renal pathological examinations. All patients were treated with immunosuppressive agents as well as DFPP therapy daily or once every other day. OP-08W plasma separators and EC-20W or EC-30W plasma fractionators (Asahi, Japan) were used. One to one and a half of calculated plasma volume was processed in each session. Serum anti-GBM antibodies were detected by an ELISA test kit (Euroimmun). Serum total IgG, plasma albumin and fibrinogen were measured. Results We totally performed 53 DFPP sessions, with 4-9 sessions for each patient. The average plasma volume being exchanged was 1.26±0.14 times of the calculated body plasma volume. The initial levels of anti-GBM antibodies were 159.94±67.02 RU/ml (82 to 262 RU/ml). The levels of anti-GBM antibodies after DFPP sessions decreased in a liner manner despite the difference of initial levels among patients, with the slope rate from -16.3 RU/ml/session to -29.9 RU/ml/session and the average slope -20.27±1.10 RU/ml/session. Serum albumin dropped significantly after each session using plasma as replacement fluid, but remained unchanged in sessions using 8% albumin solutions. Serum IgG dropped in an exponential way. Plasma fibrinogen decreased 49.5±8.9% after each session. Conclusions Combined with immunosuppressive therapy, DFPP efficiently removed anti-GBM antibodies in this study. Anti-GBM antibodies dropped in a similar rate among patients, suggesting the possibility for physicians to estimate the total sessions needed to reach the target of negative anti-GBM test. High concentration of albumin solution can be used for the compensation of albumin loss during the therapy. Because plasma fibrinogen levels decreased obviously after DFPP, invasive procedure should be performed with caution.

Key words: Double-filtration plasmapheresis, Anti-glomerular basement membrane antibody, Anti-glomerular basement membrane disease

程叙扬金其庄毛微波鲍云飞于重燕左力. 双重血浆置换清除抗肾小球基底膜抗体效果研究[J]. , 2009, 8(3): 147-151.

CHENG Xu-yang;JIN Qi-zhuang;MAO Wei-bo;BAO Yun-fei;YU Chong-yan;ZUO Li. Clearance of anti-glomerular basement membrane (GBM) antibodies and immunoglobulin by double-filtration plasmapheresis in patients with anti-GBM disease[J]. , 2009, 8(3): 147-151.