血浆置换治疗重症类风湿性关节炎临床疗效分析

目的观察血浆置换(PE)治疗重症类风湿性关节炎(RA)临床疗效。方法采用0.9%NaCl、706代血浆、病毒灭活血浆组成的置换液治疗52例重症RA患者,并与常规药物治疗45例重症RA患者组进行比较,分析两组患者治疗前后血清中IgG、IgA、IgM、C3、C4、C1q、CIC、CRP、ESR、RF共10项实验室指标的变化,并观察和统计患者血浆置换过程中的不良反应情况。结果重症RA患者经血浆置换后,血清中的IgG、IgA、IgM、C3、C4、C1q、CIC、CRP、ESR、RF较血浆置换前明显降低(P<0.05),患者临床症状明显改善;药物对照组治疗后,血清中仅有IgG、C1q、RF共3项指标较治疗前明显降低(P<0.05)。血浆置换组患者的总有效率为96.2%,高于药物治疗组患者75.5%的总有效率(P<0.01)。208次血浆置换过程中发生15次不良反应(发热反应8次,过敏反应4次,低钙血症3次),不良反应发生率为7.2%,症状均较轻,对症处理后好转。结论血浆置换治疗重症RA的疗效肯定,安全性较好。

Analysis on clinical efficacy of plasma exchange in treatment of severe rheumatoid arthritis

Objective To observe the treatment effect of plasma exchange on severe rheumatoid arthritis （RA）. Methods Trial group including 52 severe RA patients was treated by exchange fluid composed of0. 9% NaC1, Hetastarcb and virus-inactivated plasma. Control group including 45 severe RA patients was treated with routine therapy. Their laboratory parameters including IgG, IgA, IgM C3, C4, Clq, C1C, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR） and rheumatoid factor （RF） were observed before and after treatment. Meanwhile, adverse response was explored during plasma exchange. Results All the laborato- ry parameters were significantly decreased after plasma exchange in the trial group （ P 〈 0.05 ） , and, the clinical conditions were improved significantly. In the control group, only IgG 、 C1 q and RF were significantly decreased after treatment. There was a signifi- cant difference in total effect （96.2% vs 75.5% ） between the two group （P 〈 0.01 ）. There were 15 adverse reactions during 208 times of plasma exchange including fever （8 times）, allergic reaction （4 times） and hypocalcemia （3 times）. The adverse re- sponse counted for 7.2%, and the mild symptoms were improved after symptomatic treatment. Conclusion It is indicated that plasma exchange is safe and has confirmed treatment effect on severe RA patients.