双重滤过血浆置换治疗难治性重症肌无力的研究

目的探讨多次双重滤过血浆置换治疗难治性重症肌无力的方法、临床疗效和应用价值。方法23例难治性重症肌无力患者全部采用双重滤过血浆置换法治疗4次，3～4d置换1次，置换液为20％白蛋白50ml加706代血浆1000ml。治疗前及每次置换完成后第3天抽空腹血查乙酰胆碱受体抗体（AchR—Ab），并根据临床绝对评分法评分和相对评分法判断临床疗效。结果痊愈1例，基本痊愈2例，显效9例，好转8例，无效3例，总有效率为86．96％。结论多次双重滤过血浆置换能有效降低血液中较高的AchR—Ab水平，对治疗难治性重症肌无力具有重要的临床价值。

Study on double filtration plasmapheresis in treatment of refractory myasthenia gravis

Objective To discuss the therapeutic measures, clinical efficacy and application value of double filtration plasmapheresis （DFP） in treatment of patients with refractory myasthenia gravis （MG）. Methods Twenty - three patients with refractory MG were treated with DFP for four times, and PDF was performed every 3 -4 days. The exchanging liquid was composed of 20% albumen and 1000 ml plasma substitute. Physical examination for absolute clinical scores and blood samples for determination of acetylcholine recptor antibody （ AchR - Ab） were collected before DFP and on day 3 after DFP. Results Patients were assessed by grades as follows ： cure in 1 case, essential cure in 2, remarkable effect in 9, effect in 8 and failure in 3 respectively, and the total effective rate was 86.96%. Conclusion DFP may effectively lower blood AchR - Ab level and it is valuable for treatment of patients with refractory myasthenia gravis.