血浆置换治疗难治性类风湿性关节炎的疗效和安全性观察

目的探讨血浆置换(plasma exchange,PE)治疗难治性类风湿关节炎的疗效和安全性。方法入选患者18名均进行PE,检测PE前后患者IgG、IgA、IgM、ESR、CRP、RF含量。观察患者置换中不良反应及临床症状改善情况。结果PE治疗后较置换前IgG、IgA、IgM、ESR、CRP、RF含量差异有统计学意义;临床症状均明显改善;1例首次治疗后出现轻微反跳现象,3例出现不良反应(不良反应率为16.7%),症状均较轻,对症处理后好转。结论PE治疗难治性类风湿关节炎的疗效肯定,起效快,尤其短期疗效显著,毒副作用小,安全性好。     

血浆置换并联或串联血液滤过治疗肝衰竭疗效比较

目的 比较血浆置换(PE)并联或串联血液滤过(HF)治疗慢加亚急性肝衰竭的疗效.方法 将2006年1月-2007年8月住院的77例肝衰竭患者随机分为单纯PE组(39例)以及PE并联或串联HF组(PE+HF组,38例),并与同期住院未行人工肝支持治疗的患者(对照组,41例)进行对照,比较3组患者的存活率和生化指标改善情况.结果 3组患者治疗前生化指标比较差异均无统计学意义.PE组和PE+HF组治疗后血白蛋白(Alb)、胆碱脂酶(ChE)、凝血酶原活性(PTA)均升高,总胆红素(TBIL)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)均下降(P＜0.05或P＜0.01),提示生化指标均改善明显.PE组存活率为48.7%(19/39),PE+HF组为68.4%(26/38),对照组为29.3%(12/41),其中PE+HF组存活率显著高于对照组,差异有统计学意义(X2=12.11,P＜0.01).且PE+HF组治疗后肝性脑病患者意识转清率明显高于PE组(42.8%比0,P＜0.05).PE+HF组内环境紊乱纠正比例(19/23)较PE组(0/21)高(P＜0.05).结论 PE并联或串联HF治疗肝衰竭的疗效优于单用PE治疗.     

血浆置换在原发性巨球蛋白血症中的临床疗效

目的分析血浆置换在原发性巨球蛋白血症中的治疗效果。方法应用MCS＋血细胞分离机对4例原发性巨球蛋白血症患者进行血浆置换,平均置换2 944 ml/次,每人平均置换2.5次,并联合常规治疗。血浆置换前后检测下列指标：Hb、HCT、WBC、BPC、ESR、免疫球蛋白（IgM、IgG、IgA）。结果全部患者临床症状明显好转,血清IgM明显下降（P〈0.001）,血沉明显减慢（P〈0.005）,BPC轻度下降（P〈0.05）,Hb、HCT、WBC、IgG、IgA无明显变化（均P〉0.05）。结论血浆置换治疗原发性巨球蛋白血症疗效明显。     

血浆胆红素吸附联合小剂量血浆置换治疗严重肝衰竭的临床研究

目的探讨血浆胆红素吸附(PBA)联合小剂量血浆置换(PE)治疗严重肝衰竭的临床疗效。方法选取2016年3月至2017年3月该院ICU收治的100例严重肝衰竭患者作为研究对象,按随机数字表法将其分为PE治疗组和联合组,每组各50例,检测两组总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、凝血酶原时间(PT)、凝血酶原时间活动度(PTA)、清蛋白(ALB)、总胆固醇(TC)、C反应蛋白(CRP)和血氨(NH3)水平,观察治疗疗效和不良反应发生情况。结果联合组治疗后联合组ALT、AST、TBIL和NH3水平明显下降,PT明显缩短,ALB、PTA、TC明显上升,与治疗前比较差异有统计学意义(P0.05)。联合组治疗有效15例,有效率为30.0%;PE组中治疗有效6例,有效率为12.0%;联合组治疗有效率明显优于PE组(P0.05)。联合组治疗后出现1例低血压、1例低烧,不良反应总发生率为4.0%;PE组治疗后出现5例低血压、6例不同程度出血、8例发热、7例寒战,不良反应总发生率为52.0%;联合组不良反应总发生率明显低于PE组,差异有统计学意义(P0.05)。结论PBA联合小剂量PE治疗严重肝衰竭时血浆用量少且安全可靠,有效降低了不良反应发生率,为临床治疗提供了更多选择。     

双重血浆置换清除抗肾小球基底膜抗体效果研究

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。方法入选北京大学第一医院肾内科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-29.9RU/ml/次）,平均斜率（-20.27±1.10）RU/ml/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。     

血浆置换联合连续性血液净化与间歇性血液透析对尿毒症脑病疗效比较

目的:比较血浆置换联合连续性血液净化与间歇性血液透析治疗尿毒症脑病的疗效。方法:23例尿毒症脑病患者,14例行血浆置换联合连续性血液净化(Ⅰ组),9例行间歇性血液透析(Ⅱ组)治疗。观察病情缓解所需的时间、不良反应,以及透析前、透析后1,2,3,4 d清晨血肌酐、尿素氮、碳酸氢根离子及动脉血pH值的变化。结果:Ⅰ组患者1周内病情全部缓解,缓解率100%;Ⅱ组治疗1周缓解率仅37.5%;2周缓解率87.5%。Ⅰ组病情缓解平均时间(3.2±2.1)d;Ⅱ组(9.2±3.6)d,差异有统计学意义(P<0.01)。治疗期间Ⅰ组血肌酐、尿素氮、血碳酸氢盐、动脉血pH值波动小,组间比较差异无统计学意义(P>0.05);而Ⅱ组波动大(P<0.05)。Ⅱ组每日晨血肌酐、尿素氮均高于Ⅰ组,血碳酸氢根和动脉血pH值低于连续性血液净化组(P<0.05)。结论:治疗尿毒症脑病尤其是重症患者的疗效血浆置换联合连续性血液净化优于间歇性血液透析。     

血浆置换联合双重血浆分子吸附系统治疗亚急性重型肝炎

目的:探讨血浆置换联合双重血浆分子吸附系统治疗亚急性重型肝炎的临床效果。方法:选取2017年1月～2019年1月收治的76例亚急性重型肝炎患者为研究对象,按治疗方法不同分为对照组及观察组,各38例。对照组采取血浆置换治疗,观察组采取血浆置换联合双重血浆分子吸附系统治疗。比较两组临床疗效、肝肾功能指标、电解质水平及不良反应发生情况。结果:两组临床治疗有效率比较无显著性差异(P0.05);两组治疗后总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平均较治疗前明显下降(P0.05),但组间比较无显著性差异(P0.05);观察组治疗后清蛋白水平下降,对照组上升,观察组治疗后清蛋白水平低于对照组(P0.05);两组治疗前后尿素氮、肌酐、血钠水平无明显变化,组间、组内比较均无显著性差异(P0.05);治疗前,两组血钾水平比较,无显著性差异(P0.05);治疗后,观察组血钾水平呈上升趋势,且明显高于对照组(P0.05);对照组治疗前后血钾水平无明显变化,组内比较无显著性差异(P0.05)。两组治疗期间均无管路凝血、血压下降等不良反应。结论:亚急性重型肝炎患者采取血浆置换联合双重血浆分子吸附系统治疗疗效显著,可改善肝功能,并能减少血浆用量,利于人工肝治疗的进行。     

血浆置换联合激素和免疫抑制剂治疗系统性红斑狼疮的临床观察

目的观察血浆置换联合激素和免疫抑制剂方案治疗系统性红斑狼疮的疗效,并观察其不良反应。方法 30例初诊红斑狼疮患者通过投掷硬币法分为治疗组和对照组,治疗组15例行血浆置换联合强的松和环磷酰胺治疗,对照组15例单用强的松和环磷酰胺治疗,观察2组治疗后临床症状、实验室资料及药物不良反应数据。结果治疗后2组间血小板、血沉、补体C4、白蛋白、IgA、IgM、γ-球蛋白比较差异均有统计学意义(P均<0.05);治疗组发热、红斑、关节痛好转率(100%、93.3%和93.3%)均明显高于对照组(73.3%、53.3%和60.0%),P均<0.05。治疗组出现低钙手足抽搐3例,未见其他不良反应。结论血浆置换联合激素和免疫抑制剂治疗系统性红斑狼疮可使患者的临床症状和化验指标得到明显改善,提高临床疗效。     

双重膜滤过式血浆置换治疗巨球蛋白血症近期疗效观察

目的探讨双重膜滤过式血浆置换(double filtration plasmapheresis,DFPP)治疗巨球蛋白血症的临床疗效。方法回顾性分析在中国医科大学附属第一医院住院治疗的巨球蛋白血症患者16例,按照治疗方式的不同分为DFPP组(8例)与常规化疗组(8例),观察2组患者的近期疗效。结果治疗3个月后,DFPP组比常规化疗组患者血清免疫球蛋白IgM显著下降(t=4.192,P0.01)。疗效评价:DFPP组8例中,7例DFPP同时联合化疗,2例完全缓解,5例部分缓解;1例因肝功能严重异常未联合化疗,未缓解;常规化疗组8例患者仅予MPT方案化疗,0例完全缓解,5例部分缓解,3例未缓解。结论DFPP是治疗巨球蛋白血症的安全、有效、快捷的治疗方法之一。DFPP联合化疗可以迅速缓解巨球蛋白血症患者的临床症状,快速改善血生化指标,取得较好的近期疗效。     

血浆置换与丙种球蛋白治疗急性吉兰-巴雷综合征疗效分析

目的探讨血浆置换（plasmaex change,PE）或静脉用丙种球蛋白（intravenous immunoglobulin,IVIG）治疗急性吉兰-巴雷综合征（Guillain—Barre syndrome,GBS）的近期疗效及安全性。方法36例急性GBS患者随机分为2组各18例,PE组在营养神经、早期康复干预、呼吸机辅助呼吸、对症支持等常规治疗基础上给予PE治疗,IVIG组在常规治疗基础上给予IVIG静脉滴注,比较2组治疗前,治疗后1,7,14d及1,6个月Hughes评分,治疗前、治疗后7d血浆IgG、IgA、IgM、补体C3、C4及总蛋白水平。结果2组治疗后7d血浆补体C3,C4及免疫球蛋白IgG,IgA,IgM水平及治疗后14d及1,6个月Hughes评分均较治疗前下降（P〈0．05或P〈0．01）;2组治疗后各指标水平及各时间点Hughes评分比较差异均无统计学意义（P〉0．05）。结论PE及IVIG均是治疗急性GBS安全有效地方法。     

Plasma exchange versus double filtration plasmapheresis in the treatment of Guillain-Barré syndrome.

Previous studies have shown that both plasma exchange (PE) and double filtration plasmapheresis (DFPP) are effective treatments in Guillain-Barré syndrome (GBS). Whether PE and DFPP have similar effects in GBS is not clear. This report compares the therapeutic effectiveness of PE and DFPP in GBS patients treated in 3 major hospitals in northern Taiwan. A total of 102 patients were included in this survey, including 39 with PE (hereafter PE group) and 63 with DFPP (hereafter DFPP group). Both groups showed significant improvement of disability scores after treatment. However, time to onset of effect was shorter (5.6 +/- 3.5 versus 7 +/- 3.4 days, p < 0.05), and changes of disability scores were more prominent (1.3 +/- 0.8 versus 0.8 +/- 0.8, p < 0.05) in the PE group than the DFPP group. Mortality and outcome after 6 months were not different between the 2 groups. In conclusion, both PE and DFPP are effective treatments in GBS. PE was superior to DFPP in short-term effectiveness. The long-term effectiveness was not different.     

Ability to remove immunoglobulins and antiganglioside antibodies by double filtration plasmapheresis in Guillain-Barré syndrome: is it equivalent to plasma exchange?

The value of plasma exchange (PE) in Guillain-Barré syndrome (GBS) is well established. In Japan, patients with GBS and related diseases often receive double filtration plasmapheresis (DFPP) as well as PE. No comparative trials between PE and DFPP, however, have been conducted. We compared their abilities to remove immunoglobulins and antiganglioside antibodies to find out whether DFPP is equivalent to PE. The ability to remove immunoglobulins and antiganglioside antibodies was compared between PE and DFPP using plasma samples from 41 patients with GBS and related diseases before and after each treatment session. The ability of DFPP to remove both IgGs and antiganglioside IgG antibodies were significantly inferior to those of PE. There is a less theoretical basis for selecting DFPP as the first choice of plasmapheresis for GBS and related disorders.     

治疗性血浆置换的临床应用(附50例报告)

目的 回顾性分析治疗性血浆置换的适应症、疗效及并发症，为血浆置换的临床应用提供理论依据及实际经验。方法 收集1999年6月至2002年6月三年中在我中心行血浆置换治疗的患共50例，男36例，女14例，年龄9—80岁，治疗次数1—12次，共治疗142例次，其中单重血浆置换39例、111例次，双重滤过血浆置换11例、31例次；血浆置换量一般为1—2个血浆容量；单重血浆置换补充液5／6为新鲜血浆，1／6为血浆代用品；双重滤过血浆置换置换液为4％白蛋白林格氏液500ml，废弃血浆500ml，治疗前后记录病情变化及做相应的生化检查。结果 50例患的临床症状及生化检查均有不同程度的改善，病情重、首次发病效果更明显；共有12例患、18例次出现不同程度的口周及四肢麻木、荨麻疹、寒战、发热和低血压等，经对症处理后好转；4例患、5例次发生体外凝血。结论 血浆置换的临床应用已扩大至内科的各个领域，尤其是神经系统疾病、肾脏疾病、免疫性疾病及其它一些急危重疾病的治疗取得比较满意的疗效，能够迅速缓解症状，为疾病的病因治疗创造时机。     

Plasma adsorption in critical care.

Plasmapheresis therapies such as plasma exchange (PE), double filtration plasmapheresis (DFPP), or immunoadsorption plasmapheresis (IAPP) have become therapeutic tools in critical care. PE or DFPP are limited by their non- or semiselective removal of all plasma components. Replacement fluids such as fresh frozen plasma and albumin are necessary during PE or DFPP. There is the risk of infection and allergic reactions whenever such fluids are used. On the other hand, IAPP is superior to PE and DFPP because it does not require any replacement fluid. There has been development of many adsorbent columns used for removing specific pathogenic substances, and patients with various kinds of critical illness have been treated with IAPP. However, IAPP can be applied only for certain diseases because of the limitations of the commercially available columns. It is concluded that the development of new adsorption therapy may improve the high mortality and morbidity rate in critically ill patients.     

双重滤过血浆置换治疗难治性类风湿关节炎的疗效观察

目的 探讨双重滤过血浆置换(DFPP)治疗难治性类风湿关节炎(RA)的临床疗效.方法 经两或三种改善病情的抗风湿药(DMARDs)规范治疗3～6月以上、病情不能缓解的活动性RA患者82例,随机分为DFPP组42例和非DFPP组40例.均给予柳氮磺胺吡啶+甲氨堞呤治疗;DFPP组在此治疗的基础上予以DFPP治疗.随访12～24个月.DFPP治疗结束后次日及随访结束时进行评估,通过疾病活动指标及类风湿因子、功能评估(HAQ)及美国风湿病学会推荐RA病情改善ACR标准判断临床疗效.结果 ①DFPP组ACR20、ACRS0和ACR70分别为100%、92.9%和81.0%,明显高于非DFPP组(17.5%、0、0,P<0.001),并于随访1～24个月后保持不变.②DFPP组功能评估明显改善,非DFPP组无变化,两组相比差异有统计学意义(P<0.001).③DFPP组疾病活动指标、类风湿因子明显下降,变化显著高于非DFPP组(P<0.001).结论 DFPP可迅速控制难治性RA患者的病情,明显改善功能,提高生活质量,临床疗效显著.     

Double filtration plasmapheresis – 10-year pediatric experience as an alternative to plasma exchange

BackgroundDouble filtration plasmapheresis (DFPP) is more selective at removing antibodies compared to plasma exchange (PE), thus reducing the need for replacement blood products.MethodsWe retrospectively analyzed the records of all pediatric patients whom DFPP had been performed.ResultsIn total, 30 patients were treated with DFPP. Data were available for 436 sessions in 23 patients. Patients had a median of 6 (1–161) sessions. Age at start of treatment was 13.9 years (2.2–19.2) and weight 46 kg (13.4–82.8).Six patients were treated for antibody mediated rejection; 1 had full recovery, 1 CKD stage 4 and 4 required dialysis. Two patients were treated for recurrence of focal segmental glomerulosclerosis (FSGS) with good response. One successfully had an ABO-incompatible kidney transplantation. Five had anti-glomerular basement membrane disease; 3 had complete recovery, 1 CKD and 1 required transplantation. Three had granulomatosis with polyangiitis; 1 with full recovery, 1 had CKD and 1 required dialysis. Two had Type-2 Membrano-proliferative glomerulonephritis, 1 successfully treated, the other needing dialysis. One treated for rapidly progressive MPO-glomerulonephritis required dialysis. Other indications were Myasthenia Gravis, Guillain-Barré disease and autoimmune limbic encephalitis.Excluding FSGS patients (with >100 sessions), one patient had cryoprecipitate, 2 had blood transfusions, no other blood products were required. Minor complications were seen in 13 sessions (8.4%). No major complications were seen.ConclusionDFPP is a safe, well tolerated form of apheresis that appears to have comparable outcomes to that of PE, without the routine need of replacement blood products.     

Double filtration plasmapheresis for the treatment of bullous pemphigoid: a three case report.

Bullous pemphigoid (BP) is an autoimmune disease caused by an antidermal basal lamina antibody. In recent years double filtration plasmapheresis (DFPP) has been reported to be an effective therapy for BP. We experienced 3 cases of BP treated by DFPP. DFPP resulted in an improvement in clinical symptoms and remission allowing a decrease in the required dose of corticosteroid. DFPP was found to be an effective treatment for all 3 patients without noticeable adverse events resulting from DFPP. From these results it is concluded that DFPP is worth considering as an option as treatment for BP patients who were unresponsive to conventional steroid therapy, those in whom corticosteroids should be reduced or discontinued because of complications such as diabetes mellitus and/or osteoporosis.     

Comparative study of clinical effects between plasma adsorption and double filtration plasmapheresis in patients with myasthenia gravis.

Plasma exchange (PE) has been one of the most powerful treatments for patients with myasthenia gravis (MG) since Pinching et al. reported its clinical usefulness in 1976, despite the need for supplemental human plasma. However, new apheresis techniques, e.g., plasma adsorption (PA) and double filtration plasmapheresis (DFPP), which do not need human plasma, were developed and have been introduced for clinical use in MG. We compared the effects of these plasma purification therapies in patients with MG and found that DFPP improved such subjective symptoms as chest compression and general fatigue better than PA while both of them could decrease the serum level of acetylcholine receptor (AChR) antibodies and relieve objective muscle weakness to a similar degree. It may be that DFPP can remove some circulating pathogenic factors other than AChR antibodies more efficiently than PA.     

Therapeutic apheresis in multiple sclerosis

Therapeutic apheresis is divided in cytapheresis and plasmapheresis. And plasmapheresis(PP) is divided into three treatments, plasma exchange(PE), double filtration plasmapheresis(DFPP) and immunoadsorption plasmapheresis(IAPP). PE has been applied in the neuroimmunological disorders and the effectiveness of PP has been well established in some neuroimmunological disorders. In this article, PP treatment of multiple sclerosis(MS) was reviewed. PP is an effective means of removing the pathogenic immune-mediated factors, such as inflammatory cytokines, autoantibodies, immune complexes, and complements. PP may affect not only humoral immune responses but also cellular immune responses. Previous clinical reports suggested that PE might be effective in treating acute attacks of MS, but be no effective in patients with chronic progressive MS. IAPP may be superior to PE in the treatment of MS.