恶性浆细胞病高黏滞综合征及治疗性血浆置换的微循环学研究

The microcirculational research of hyperviscosity syndrome in malignant plasma cell disorder treated with therapeutical plasma exchange

目的研究恶性浆细胞病(MPLD)中高黏滞综合征(HVS)发病的微循环学基础及治疗性血浆置换(TPE)治疗HVS的微循环学依据。方法71例合并HVS的MPLD随机分为无贫血组(NAG组)和贫血组(AG组),行微循环学检测。其中42例应用TPE治疗,与治疗前进行统计学比较。结果TPE治疗前HVS甲襞微循环积分显著增高(P<0.05),AG组高于NAG组。NAG组全血黏度、还原黏度、血浆黏度、红细胞刚性及聚集指数均高于对照组(P<0.05),AG组可见全血黏度显著降低,血浆黏度、全血还原黏度、红细胞刚性及聚集指数显著增高(P<0.05)。TPE后NAG组管襻形态及血液流态积分较治疗前显著降低(P<0.05),AG组管襻形态及血液流态积分显著降低,但高于对照组(P<0.05)。2组襻周状态及总积分显著降低,但高于对照组(P<0.05),AG组总积分高于NAG组。NAG组全血黏度、血浆黏度、全血还原黏度、红细胞刚性及聚集指数显著降低(P<0.05)。AG组全血黏度显著降低并显著低于对照组(P<0.05)。血浆黏度、全血还原黏度、红细胞刚性及聚集指数显著降低(P<0.05)。结论MPLD患者HVS的微循环异常主要是由M蛋白增高所致,贫血也可加重微循环异常。TPE可快速清除M蛋白,改善微循环异常,是有效治疗HVS的重要方法。

Objective To study the basis of microcirculational of hyperviscosity syndrome in malignant plasma cell disorder treated with therapeutical plasma exchange. Methods 71 patients with HVS combined MPLD were randomly divided into non-anemia group（ NAG group）and anemia group（ AG group） ,for detection of micro-clrculation study. 42 eases in which application of TPE treatment, were compared with those before treatment. Results Before treatment by TPE, the nailfold microcirculation points of HVS was significantly higher（ P 〈 0. 05 ） , AG group was higher than NAG group. The whole blood viscosity,reduced viscosity, plasma viscosity, erythrocyte rigidity and aggregation index of NAG group were higher than control group（ P 〈 0.05 ）, AG group shows a significant reduction in whole blood viscosity, plasma viscosity, whole blood reduced viscosity, erythrocyte rigidity and aggregation index was significantly higher（ P 〈 0.05 ）. After TPE, the pipe-loop morphology and blood flow pattern points of NAG group were significantly lower than that before treatment （ P 〈 0.05 ）, the tube-loop morphology and blood flow pattern points of AG group were significantly reduced,but higher than that in control group（ P 〈 0.05 ）. The loop-week status and the total score of these two groups value descended remarkably, but higher than the control group （ P 〈 0. 05 ）, the total score of AG group were higher than NAG group. The whole blood viscosity, plasma viscosity, whole blood reduced viscosity, erythrocyte rigidity and aggregation index of NAG group were significantly lower（ P 〈 0.05 ）. The whole blood viscosity of AG group were significantly reduced and lower than control group（ P 〈 0.05 ） , the plasma viscosity, whole blood reduced viscosity,erythrocyte rigidity and aggregation index were significantly lower（ P 〈 0.05 ）. Conclusion Microcirculation abnormalities in patients with HVS combined MPLD are caused by the M protein increasing,anemia may also add it. TPE can quickly clear the M-protein,improving the abnormal microcirculation,is an important method of effective treatment of HVS.