血浆置换治疗重症类风湿关节炎的疗效和安全性评价

The efficacy and safety of plasma exchange in the treatment of severe rheumatoid arthritis

目的评价血浆置换治疗重症类风湿关节炎(RA)的疗效和安全性。方法入选RA患者48例均进行血浆置换,同时口服甲氨蝶呤及柳氮磺胺吡啶或来氟米特。第1次血浆置换前和血浆置换后1周进行临床观察及评估。疗效评价主要以美国风湿病学会(ACR)疗效评价指标为标准。结果血浆置换治疗后1周,患者多项观察指标如肿胀关节数、触痛关节数、晨僵时间、静息痛视觉模拟评分(VAS)、血沉(ESR)和C反应蛋白(CRP)等均有明显改善,与治疗前比较差异有统计学意义(P≤0.01)。血浆置换治疗后1周达到ACR20患者为52%,达到ACR50患者为12.5%。48例患者血浆置换过程中出现不良反应4例,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,起效快,短期疗效显著,毒副作用小,安全性好。

Objective To assess the clinical efficacy and safety of plasma exchange in the treatment of severe rheumatoid arthritis（RA）. Methods Forty-eight patients with severe RA were enrolled. Patients were assessed before and after plasma exchange. Results One week after plasma exchange, swollen joint count, tender joint count, duration of morning stiffness, pain VAS count, CRP, and ESR were obviously improved. 52% patients reached 20 percent improvement（ ACR 20% ） ,and 12.5% patients reached 50 percent improvement（ ACR 50）. Four cases had slight adverse effect. Conclusion Plasma exchange is rapidly effective in patients with severe rheumatoid arthritis.