血浆置换治疗系统性红斑狼疮体会

血浆置换治疗系统性红斑狼疮体会暨南大学医学院肾内科（５１０６３２）林日英，尹良红，郑绮宜系统性红斑狼疮是一种自身免疫性疾病，常累及全身多个器官，特别是皮肤，关节和肾脏，血清中有多种自身抗体，特别是抗核抗体，抗双链ＤＮＡ抗体是本病的特征性标志。病程迁延...     

血浆置换并中西医结合治疗重症系统性红斑狼疮

系统性红斑狼疮 (systemic lupus erthematosus,SL E)是一种具有多种自身抗体的自身免疫性疾病。目前对重症系统性红斑狼疮 (SSL E)尚无理想疗法。我们探索用血浆置换 (plasma ex-change,PE)并中西医治疗 7例 SSL E,取得满意临床效果 ,报道如下。1　材料和方法1.1　病例选择　 7例 SSL E均为住院患者 ,男 1例 ,女 6例 ,年龄 2 1～ 35岁。均符合美国风湿学会 1982年修订的 SL E诊断标准。其中 5例为狼疮危象[1 ] ,2例为急进性狼疮性肾炎[1 ] ,病程 5天至 3年 ,7例患者均有蛋白尿 ,5例狼疮危象者肾脏病理类型为 3例系膜增生、1例微小…     

血浆置换治疗系统性红斑狼疮37例的护理

系统性红斑狼疮 (systemiclupuserythmatosus,SLE)是一种累及多系统、多器官 ,具有多种自身抗体的自身免疫性结缔组织病。本病以青年女性多见 ,血浆置换 (PlasmaExchangPE)作为一种新的治疗方法已用于临床上多种疾病的治疗 ,它能去除血浆中的病理成份 ,将正常成份回输给病人 ,同时输入等量的血浆替代品 ,通过交换能减少血浆中的可溶性免疫复合物、抗基底膜抗体以及其他免疫活性物质[1 ] ,达到治疗的目的。我院从 1 997年开始至今对 37例SLE病人进行血浆置换 1 0 3次 ,使SLE临床症状得到了有效的控制。现将护理介绍如下。1　临床资料1 …     

血浆置换治疗系统性红斑狼疮10例的护理

系统性红斑狼疮是一种自身免疫性结缔组织病，由于患者体内有大量致病性自身抗体和免疫复合物，造成组织损伤，临床可出现全身多系统和脏器损害的症状。我科应用血浆置换治疗系统性红斑狼疮患者取得显著效果，现介绍如下。     

系统性红斑狼疮血浆置换的护理体会

血浆置换(简称PE)临床应用是近几十年来医学领域里新发展起来的一项治疗措施。PE是将患者分离出的血浆弃除,并补充一定量的血浆,以清除体内可溶性免疫复合物和抗基膜抗体以及血浆中其他免疫活性物或蛋白结合的毒物。临床上针对系统性红斑狼疱(SLE)的免疫发病机理,应用免疫抑制剂结合PE,使治疗上可获得较长时期缓解。     

血浆置换和免疫吸附治疗系统性红斑狼疮现状

血浆置换及免疫吸附疗法为难治性狼疮的治疗提供了更多的选择手段。本文重点介绍血浆置换和免疫吸附治疗适应证和并发症     

血浆置换联合DNA免疫吸附血液灌流治疗难治性系统性红斑狼疮

2003年2月-2005年3月，用血浆置换联合DNA免疫吸附血液灌流治疗难治性系统性红斑狼疮（SLE），疗效满意，报告如下。     

血浆置换治疗系统性红斑狼疮并发症28例护理体会

目的:探讨血浆置换(PE)治疗系统性红斑狼疮(SLE)的护理措施。方法:回顾2003~2005年住院的SLE患者28例62次PE治疗的临床资料,分析常见并发症及其原因,有针对性地进行护理干预。结果:PE治疗常见并发症有低血压、过敏反应、出血及感染。结论:针对相关因素有预见性地及时正确地采取护理措施,能最大限度地减少并发症发生。     

系统性红斑狼疮患者行血浆置换的临床观察及护理

传统性红斑狼疮（ＳＬＥ）是一种具有多种自身抗体的自身免疫性疾病，用血浆置换（ＰＥ）可迅速去除ＳＬＥ患者循环系统中的抗原、抗体和免疫复俣物，使患者的病情能迅速得到缓解或控制。在ＰＥ治疗过程中护理工作是非常重要的，我们通过严密的观察、早期预防及护理，保证了ＰＥ的顺利进行，有效地预防了并发症的发生，提高了治疗效果，使患者的病情得到及时地控制和缓解。     

Plasma exchange for systemic lupus erythematosus.

Efficacy of plasma exchange in patients with systemic lupus erythematosus has not been supported by the results of the first non-controlled and retrospective studies. Nonetheless, they remain relevant for some selected patients with life-threatening manifestations and/or severe therapy-resistant manifestations. They can be used as an adjuvant therapy in combination with corticosteroids and, when required, other immunosuppressant(s) for refractory renal disease, alveolar hemorrhage, some neuropsychiatric manifestations, thrombotic thrombocytopenic purpura, catastrophic antiphospholipid syndrome, hyperviscosity syndrome or symptomatic cryoglobulinemia. The use of newer technologies, like immunoadsorption, possibly in combination with recent biologics, might, in the future, offer some new perspectives for extracorporeal therapy of systemic lupus erythematosus.     

Mutation of a 5,10-methylenetetrahydrofolate reductase gene in systemic lupus erythematosis and antiphospholipid syndrome

AIM: To study prevalence of mutation C677T in gene 5.10-MTHFR in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) as well as in persons free of symptoms of systemic diseases of the connective tissue. MATERIAL AND METHODS: 85 patients participating in the study were divided into three groups: those with SLE (n = 17), with SLE + APS (n = 42), with primary APS (n = 26). The control group consisted of 30 persons without SLE or APS. 55% of the examinees had thrombotic complications of different location. The diagnosis of the mutation was made using DNA isolated from the peripheral blood with standard methods and polymerase chain reaction. Allele (homozygous or heterozygous) condition of the mutation was confirmed by means of allele-specific primers. RESULTS: Mutation C677T in MTHFR gene was found in 40 of 85 patients (47%); 11(27.5%) had a homozygous variant, 29(72.5%)--heterozygous. C677T mutation occurred in 5 of 17 SLE patients (29%), it was in all the cases heterozygous. In primary and secondary APS mutation was detected in 51.5% (35 of 68 patients). Recurrent thrombosis occurred more frequently in patients with mutation MTHFR. Three and more episodes of thrombosis were registered in 17 of 40 patients with mutation C677T against 9 of 44 patients without the mutations (p = 0.04). CONCLUSION: Relationship between elevated blood levels of APL and MTHFR mutation points to the fact that this genetic marker is an additional thrombogenic factor in APS. Mutation C677T in MTHFR gene in APS patients correlates with recurrent thrombosis.     

小剂量IL-2治疗合并感染的重型系统性红斑狼疮1例及文献复习

<正>系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种可累及多系统、多脏器,并产生多种自身抗体的慢性自身免疫性疾病。SLE传统的治疗方法是联合使用糖皮质激素与免疫抑制剂,而由此引起的严重感染是SLE患者死亡的重要原因之一。近年来研究发现,SLE的发生可能与体内调节性T细胞(regulatory T cell,Treg细胞)数目不足或功能异常导致的免疫耐受缺陷有关。小剂量白介素(interleukin,IL)-2在上调Treg细胞表达的同时,也刺激正常淋巴细胞的活化,增强抗感染能力。现将小剂量IL-2治疗有效的1例合并感染的重型SLE病例报道如下。患者,女,25岁,主因间断皮肤红斑、脱发10年,     

38例系统性红斑狼疮天然杀伤细胞测定

目的探讨系统性红斑狼疮(SLE)患者天然杀伤(NK)细胞数的改变.方法采用免疫荧光法和流式细胞仪,时38例SLE患者及20名正常人的天然杀伤细胞数进行检测.结果活动期SLE患者天然杀伤细胞为0.07±1风湿科,2血液内科0.04,其中23例狼疮肾炎天然杀伤细胞为0.05±0.03,非狼疮肾炎天然杀伤细胞为0.10±0.03;治疗前、后天然杀伤细胞分别为0.07±0.03、0.10±0.04,组间及组内比较均P＜0.01.结论SLE的发生可使天然杀伤细胞数下降.     

Sclerosing peritonitis and systemic lupus erythematosus: a report of two cases.

OBJECTIVE: To heighten the awareness of a possible association of sclerosing peritonitis in patients with systemic lupus erythematosus (SLE). METHODS AND RESULTS: Over the course of 17 years (from January 1981 to December 1997), 371 patients were treated with continuous ambulatory peritoneal dialysis (CAPD) at Rush-Presbyterian-St Lukes Medical Center. The patients were followed on CAPD for an average of 25 +/- 21 (SD) months with a median of 19 months (range 0.2-115 months). During this time only 2 (0.5%) patients were diagnosed with sclerosing peritonitis, and both had SLE with ongoing evidence of active disease while on CAPD. With a total of 26 SLE patients being treated with CAPD during the observation period, the prevalence of sclerosing peritonitis can be said to be as high as 8% in this patient population. CONCLUSION: These cases suggest that autoimmune diseases, such as SLE, that are well known to cause immune-mediated serositis may represent an additional factor predisposing to the development of sclerosing peritonitis in patients treated with CAPD.     

Potential benefits of plasma exchange by apheresis on the treatment of severe Icteric Leptospirosis: Case report and literature review

The role of plasmapheresis on the treatment of Leptospirosis has not been define, although it has already been used with beneficial effects in the reported case mentioned above, where was possible to contribute to the resolution of the toxic effects on the tubular renal cells. This case report show how plasma exchange prevents the multiorganic failure.     

儿童系统性红斑狼疮的临床诊断：附104例报告

观察分析ＳＬＥ１３项诊断标准对儿童系统性红斑狼疮临床诊断的意义。方法：回顾性总结１０４例儿童ＳＬＥ的临床资料。结果（１）１０４例儿童患者的症状,体征和实验室检查,阳性最高的项目依次为免疫荧光法抗核抗体（ＩＦＡＮＡ）阳性（９０．１％）,蛋白尿或管型尿或血尿（８３．６％）、补体Ｃ３降低（７５．０％）,非畸形性关节炎或多关节痛（５９．６％）、抗双链脱氧核糖核酶（抗ｄｓＤＮＡ）抗体阳性或狼疮细胞（ＬＥ细胞     

Plasma exchange for hypertriglyceridemic acute necrotizing pancreatitis: report of two cases.

We report two cases of hypertriglyceridemic necrotizing pancreatitis treated by plasma exchange (PE). The outcome of each case was quite different according to the timing of PE. A 36 year old man presented with abdominal pain, and a diagnosis of severe acute pancreatitis was made. His serum triglyceride (TG) level was 6,460 mg/dl. He did not undergo PE at first, however, his condition never improved and PE was performed 20 days after the onset of his illness. Finally, he died of multiple organ failure and sepsis. In contrast, a 52 year old man with acute necrotizing pancreatitis was referred to our department. He received PE quickly after hospital admission. His serum TG level, which was 3,540 mg/dl at hospital admission, dramatically returned to normal limits, and he was discharged from the hospital 62 days after admission. The prognosis of severe necrotizing pancreatitis due to hypertriglyceridemia is extremely poor. PE should be applied for the treatment of hypertriglyceridemic necrotizing pancreatitis immediately after its onset.