血浆置换治疗240例难治性风湿病的临床疗效评价

目的：观察、评价应用血浆置换疗法结合免疫抑制剂治疗难治性风湿病的临床疗效。方法：治疗组240例难治性风湿病患者，应用血浆置换疗法结合免疫抑制剂治疗。血浆置换每周1～2次，每次去除血浆830～1500ml，4次一疗程，总量达3～6L。在活动性强直性脊柱炎(AAS)和难治性类风湿关节炎(RRA)患者，在血浆置换同时应用环磷酰胺(CTX)200mg静点，隔日1次，利美达松4mg静注，每周1次，连用4周为1个疗程。在狼疮性肾炎(LN)患者，用CTX 500mg／m^2每周静点1次，4周后改为每3月1次；同时设立对照组，45例AAS和30例RRA仅用NSAIA和SAARDs，在LN对照组14例单用iv—CTX。结果：治疗组在AAS、RRA和LN总有效率分别为97．41％、96．67％和94．74％；对照组分别为82．22％、78．13％、64．3％。在混合性结缔组织病，皮肌炎，进行性系统性硬化症，牛皮癣脊柱炎关节病和重叠综合征的治疗组总有效率分别为80％、66．66％、66．66％、100％和100％。结论：应用血浆置换结合免疫抑制剂治疗难治性风湿病疗效高、见效快、缓解期长，且副作用无明显增加。是抢救风湿病危象的一种有效措施。

Clinical effectiveness of plasma exchange in 240 cases suffering from refractory rheumatism

Objective:To assess clinical effectiveness in refractory rheumatism used plasma exchange (PE) combineds with immunodepresive.Methods:PE was done one or two time every week and four time as a course of therapy,and at the same time we used cyclophosphamide 200mg three time a week by venous trnsfusion,limethason 4mg once time a week by venoclysis in the active ankylosing spondylitis (AAS) and refractory rheumatoid arthritis(RRA).PE was done one time every week combined with cyclophosphamide 500mg one a week by venoclysis for 4 week in the lupus nephritis (LN).Results:The remarkable effective in the treatment group of AAS,RRA and LN,the total effective rate were respectively 97.41%,96.67% and 94.74% after the therapy;the total effective rate were respectively 82.22%,78.13% and 64.3% in the control group.Conclusion:The therapy of PE combination with immunodepressive to refractory rheumatism has the faster,better results,littel side effects and longer remission stage than the control group,and was a more effective measure for critical of rheumatism.