双重血浆置换治疗类风湿性关节炎活动期的作用观察

目的探讨双重血浆置换（DFPP）对类风湿性关节炎（RA）活动期患者类风湿因子（RF）、C反应蛋白（CRP）和血沉（ESR）的影响，评价DFPP对RA的作用。方法RA活动期患者在规范药物治疗的基础上予以DFPP治疗2～3次，比较单次DFPP前后血RF、CRP和ESR的变化，并观察疾病的活动性与置换出血浆颜色的关系。结果DFPP后RF、CRP和ESR下降率分别为22．55％、57．08％和50．48％，均明显低于置换前（P均〈0．001）。活动期RA患者置换出的血浆呈墨绿色、绿色或黄绿色；墨绿色混浊，黄绿色清亮；墨绿色者疾病活动指标（关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、CRP、ESR），均明显高于绿色和黄绿色患者（P均〈0．001）。结论DFPP能明显降低RA活动期患者的RF、CRP、ESR；患者置换出的血浆呈墨绿色、绿色或黄绿色；颜色深浅与疾病活动性相关，疾病活动性越高，颜色越深且越混浊。

Observation on effect of double filtration plasmapheresis on patients with active rheumatoid arthritis in active stage

Objective To investigate the effect of filtration plasmapheresis (DFPP) on blood contents of rheumatoid factor (RF), C reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in patients with rheumatoid arthritis (RA) in active stage, and to appraise the therapeutic effect of DFPP on RA. Methods The changes in contents of blood RF, CRP, ESR before and after DFPP were compared. The treatment was given for 23 times, and the activity of RA and the appearance of filtrated plasma were compared before and after the treatment. Results There were dramatic reductions of the levels of RF, CRP, ESR after single DFPP by 22.55%, 57.08%, and 50.48%, respectively, compared with those before the treatment (all P <0.001). The color of the filtrate was green in RA in active stage. The cases with dark green filtrate had higher active indexes (pain, tenderness, swelling) and blood contents of CRP and ESR than those with green or yellowgreen ones (all P <0.001). Conclusion DFPP can remarkably reduce the level of RF, CRP, ESR of blood. The filtrate of RA in active stage appeared green. There is a relationship between the activity of RA and the color of filtrates.