淋巴血浆置换治疗吉兰-巴雷综合征的临床应用

目的:评估淋巴血浆置换(lymphoplasmapheresis,LPE)治疗吉兰-巴雷综合征(Guillain-Barre syndrome,GBS)的临床疗效及安全性.方法:将66例GBS病人随机分成治疗组和对照组.治疗组33人,在内科治疗基础上加用淋巴血浆置换;对照组33人,只进行内科治疗.通过肌力开始恢复时间、治疗前后肌力评分差值来评估疗效.观察治疗组的副反应.结果:治疗组33例患者接受LPE 48次,平均1.5次/例;治疗后肌力开始恢复时间平均为(6.45±3.01)d,早于对照组(8.36±3.831)d;肢体肌力评分治疗前后的差值大于对照组;疗效为进步者(16例)多于对照组(4例),无效者(16例)少于对照组(24例),总有效率为51.5%,高于对照组27.7%;平均住院天数为(19.42±7.25)d,短于对照组(24.00±8.64)d;差异有统计学意义(P＜0.05).第1次LPE后肌力平均评分增高,但与治疗前相比差异无统计学意义(P＞0.05);第2次、第3次LPE后肌力平均评分继续增高,与治疗前相比差异有统计学意义(P＜0.05).LPE组相关副反应发生率为12.5%,主要为荨麻疹和低血压,均轻微,对症处理后缓解. 结论:LPE疗效肯定,副反应少,是一种安全、有效的治疗方法,值得临床推广应用.

Lymphoplasmapheresis for Guillain-Barre syndrome

OBJECTIVE: To evaluate the clinical therapeutic effect and security of lymphoplasmapheresis (LPE) for Guillain-Barre syndrome (GBS). METHODS: Sixty-six GBS patients were randomly divided into 2 groups: the therapy group (33 patients) were treated with LPE in addition to the medical treatment; the control group (33 patients) only accepted the medical treatment. The therapeutic effect was evaluated with the initial recovery time of myodynamia and the myodynamia score difference, and the side effect of the therapy group was observed. RESULTS: The therapy group were treated with LPE for 48 times,1.5 times per person. The average initial recovery time was quicker in the therapy group compared with that in the control group [(6.45+/-3.01) vs (8.36+/-3.83) days]. The difference of limb myodynamia score between pre-treatment and post-treatment in the therapy group was more than that in the control group. The improved number in the therapy group was more than that in the control group, but the ineffective number in the therapy group was not as many as that in the control group. The total effective rate in the therapy group was higher than that in the control group (51.5% vs 27.7%); the average hospital day in the therapy group was shorter than that in the control group [(19.42+/-7.25) vs (24.00+/-8.64) days]; and the difference had statistical significance(P<0.05). The average myodynamia score after the first LPE increased, but the difference had no statistical significance (P>0.05). After the second and the third LPE, the average myodynamia score continued to rise, and the difference had statistical significance (P<0.05). The incidence rate of side effects in the therapy group was 12.5%. Urticaria and hypotension were the major side effects, but they were light and could be relieved by symptomatic treatment. CONCLUSION: The therapeutic effect of LPE is definite, and the side effect is scarce. LPE is safe and effective, and it is worth of generalizating and applying in clinical practice.