血浆置换疗法治疗自身免疫性大疱性皮肤病的临床疗效观察

Clinical observation on plasma exchange in the treatment of autoimmune bullous diseases

目的探讨血浆置换疗法治疗大疱性皮肤病患者的临床疗效。方法在中国医科大学附属第一医院皮肤科住院的天疱疮、大疱性类天疱疮患者共34例,按照治疗方式的不同分为血浆置换组(PE组,15例)与常规治疗组(19例)。观察2组患者激素使用剂量、减量时间、自身抗体变化、无新发水疱时间及并发症。结果①PE组患者激素的初始量、最大控制量、减量前累积量明显低于常规治疗组患者(P<0.05);②PE组患者血浆置换后血清自身抗体滴度明显下降(P<0.05);③PE组比常规治疗组患者抗体滴度下降明显(P<0.01);④PE组并发症显著低于常规治疗组患者(P<0.05)。结论血浆置换疗法可以减少自身免疫性大疱性皮肤病患者的糖皮质激素用量,显著降低血清自身抗体滴度,并发症少,特别是对于不能耐受大剂量激素及免疫抑制剂的重症患者,血浆置换取得较好的治疗效果。

Objective To observe the clinical effect of plasma exchange （PE） on autoimmune bullous diseases. Methods We recruited 34 patients with severe pemphigns or bullous pemphigoid and assigned them into PE group （15 cases） or regular treatment group （19 cases）. Result ①The initial, maximal and accumulated doses of corticosteroids were remarkably lower in PE group than in regular treatment group （P〈 0.05）. ②After PE, autoantibody tilter declined considerably （P〈0.05）. ③ The decreased of autoantibody titer was more in PE group than in regular treatment group （P〈0.01）. ④ Complication rate was also lower in PE group than in regular treatment group （P〈0.05）. Conclusion PE lowers autoantibody titer and reduces the dosage and side effects of glucocorticoids. PE is especially suitable for those intolerable to large dose of corticosteroids or other immunosuppressives.