双重滤过血浆置换治疗吉兰-巴雷综合征与视神经脊髓炎的疗效观察

目的 观察比较全血浆置换(PE)与双重滤过血浆置换(DFPP)对吉兰-巴雷综合征(GBS)与视神经脊髓炎(NMO)的治疗效果及不良反应情况.方法 选取解放军第174医院2014年5月至2016年12月17例神经系统免疫性疾病患者,其中GBS 10例,NMO 7例,所有患者均符合诊断标准.17例患者随机分为2组,PE组8例(GBS 5例,NMO 3例),DFPP组9例(GBS 5例,NMO 4例),2组患者在性别、年龄及疾病严重程度评分上差异无统计学意义(P＞0.05).PE组行全血浆置换25例次,DFPP组行双重滤过血浆置换27例次,2组均采取隔日一次血浆置换的方法,观察2组患者进行血浆置换治疗后肌力、视力恢复情况,皮肤瘙痒、低血压等不良反应发生情况,血浆免疫球蛋白、补体和纤维蛋白原变化情况.结果 2组患者的肌力、视力均获得改善.PE组总体有效率75％,DFPP组总体有效率88％,2组有效率比较差异无统计学意义(P＞0.05).DFPP组患者治疗后补体、免疫球蛋白及纤维蛋白原较治疗前均明显下降(P＜0.05).PE组有3例出现输血反应,DFPP组有1例并发感染,1例并发出血.结论 PE及DFPP均能有效地治疗神经系统免疫性疾病,临床上如血源供应紧张或患者对异体血浆不能耐受,可选择行双重血浆置换治疗,但需注意预防出血及感染等不良反应.

The treatment effect of double filtrationplasmaphersis in Guillain-Barre syndrome and neuromyelitis optica

Objective To compare the treatment effects and adverse reaction of total plasma exchange(PE)and double filtration plasm aphersis(DFPP)on the treatment of Guillain-Barre syndrome(GBS)and neuromyelitis optica(NMO).Methods 17 cases of patients were enrolled in this study,including 10 GBS and 7 NMO cases.All of patients were diagnosed according to the GBS and NMO diagnostic criteria.17 patients were divided into two groups by random: TPE group(5 GBS,3 NMO)and DFPP group(5 GBS,4 NMO)respectively.There is no significant difference between the two groups with respect to gender,age and disease severity score(P＞0.05).After patients in each group experienced 25 courses of TPE and 27 course of DFPP at one day interval,and assessment of muscle strength,visual acuity,occurrence of skin itching and low blood pressure,and the level of plasma immunoglobulin,complement and fibrinogen was done.Results Muscle strength or visual acuity were improved in two groups(75％ vs 88％,P＞0.05).In the DFPP group,the levels of complement,immunoglobulin protein and fiber protein decreased after treatment.For PE group,there were 3 patients suffering the transfusion reaction.While for DFPP group,1 patient was complicated with infection and 1 patient was complicated with bleeding.Conclusion PE and DFPP can be used to treat for autoimmune diseases of the nervous system effectively.When blood supply is tight and patients can not tolerate blood infusion,dual plasma exchange may be a choice,but need to prevent the side effects such as bleeding and infection.