中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (03): 159-162.doi: 10.3969/j.issn.1671-4091.2015.03.00

• 临床研究 • 上一篇    下一篇

血浆置换在儿科神经系统疾病中的应用

陈鹭,张桂菊,刘小荣   

  1. 首都医科大学附属北京儿童医院肾脏内科
  • 收稿日期:2014-08-18 修回日期:2014-10-15 出版日期:2015-03-12 发布日期:2015-04-20
  • 通讯作者: 张桂菊 ireneheron@163.com E-mail:ireneheron@163.com

Plasma exchange in the treatment of pediatric neurological diseases mediated by immunological abnormalities

  • Received:2014-08-18 Revised:2014-10-15 Online:2015-03-12 Published:2015-04-20

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摘要： 【摘要】目的 探讨血浆置换治疗儿童神经系统免疫障碍性疾病的疗效及不良反应。 方法 对2008年1月～2013年12月在首都医科大学附属北京儿童医院血液净化中心进行血浆置换的神经系统免疫障碍性疾病患儿进行回顾性病例分析。 结果 27例血浆置换治疗患儿中，急性炎性脱髓鞘性多发性神经根神经病(AIDP)7例，免疫介导的神经系统疾病8例(抗NMDA受体脑炎7例，桥本氏脑病1例)，慢性炎性脱髓鞘性多发性神经根神经病(CIDP)4例，重症肌无力3例，中枢神经系统脱髓鞘疾病5例(多发性硬化2例，急性播散性脑脊髓炎2例，视神经脊髓炎1例)。进行血浆置换2～4次/例，共计63例次。19例患儿明确治疗有效(19/27，70.37%)，AIDP、CIDP、重症肌无力、其他免疫介导性神经系统疾病、中枢神经系统脱髓鞘疾病的治疗有效率分别为7例(7/7，100%)、4例(4/4，100%)、2例(2/3，66.67%)、4例(4/8，50.0%)和2例(2/5，40.0%)。治疗中发生不良反应7例次(12.70%)，以过敏反应和低血压为主。 结论 血浆置换对儿童AIDP、CIDP诱导期以及重症肌无力等疾病疗效肯定，患儿耐受性好，是儿童危重、难治性神经系统免疫障碍性疾病的有效治疗手段。

关键词: 血浆置换, 神经系统免疫障碍性疾病, 儿童

Abstract: 【Abstract】 Objective To observe the efficacy and side-effect of plasma exchange (PE) in the treatment of pediatric neurological diseases mediated by immunological abnormalities. Methods We retrospectively analyzed pediatric neurological patients treated with PE in Beijing Children's Hospital Affiliated to Capital Medical University between Jan. 2008 and Dec. 2013. Results Twenty-seven neurological patients mediated by immunological abnormalities and treated with PE were recruited in this study, which included dysimmunological neuropathy (anti-NMDA receptor encephalitis 7 cases, and Hashimoto's encephalitis one case), acute inflammatory demyelinating polyneuropathy (AIDP 7 cases), chronic inflammatory demyelinating neuropathy (CIDP 4 cases), myasthenia gravis (MG 3 cases), and CNS demyelinating diseases (multiple sclerosis 2 cases, acute disseminated encephalomyelitis 2 cases, and neuromyelitis optica one case). A total of 63 PE were performed (2～4 times/case). Nineteen cases improved after PE. The effective rate was 100% (7/7), 100% (4/4), 66.67% (2/3), 50.0% (4/8), and 40.0% (2/5) in AIDP, CIDP, MG, dysimmunological neuropathy, and CNS demyelinating diseases, respectively. Adverse reactions occurred in 7 case-times (12.70%), and were mainly allergic reactions and hypotension. Conclusions PE was effective in pediatric AIDP, MG, and the induction stage of CIDP with better tolerance. PE can be used in the treatment of severe and refractory pediatric neurological diseases mediated by abnormal immunological function.

Key words: Plasma exchange, neurological disease, children