双重滤过血浆置换与血浆置换治疗重症自身免疫性疾病的比较研究

Comparative study on double-filtration plasmapheresis and plasma exchange in treatment of severe autoimmune disease

目的比较双重滤过血浆置换(DFPP)和血浆置换(PE)治疗重症自身免疫性疾病(SAID)的差异。方法 27例SAID患者分为两组,分别采用DFPP和PE进行治疗,对疗效、并发症、费用、住院时间、实验室指标等进行比较。结果 PE组平均治疗2.2次、住院时间42.5d、治疗费用3.95万元,DFPP组平均治疗2.88次、住院时间41.94d、治疗费用4.99万元。PE组显效50%,好转30%,无效20%;DFPP组显效52.94%,好转35.29%,无效11.76%;两组疗效相当。PE组并发症发生率45.45%,DFPP组并发症发生率8.16%,DFPP组并发症明显少于PE组(P<0.05)。PE后白细胞、血红蛋白、血小板、血钾、血肌酐、尿素氮、谷丙转氨酶、白蛋白、球蛋白、免疫球蛋白A(IgA)、IgG、IgM、C3没有差异(P均>0.05),只有血钠略有上升(P<0.05)。DFPP后白细胞、血红蛋白明显升高,白蛋白、球蛋白、IgA、IgG、IgM、C3明显降低(P均<0.05),血小板、血钾、血钠、血肌酐、尿素氮、谷丙转氨酶变化不大(P均>0.05)。结论 DFPP在治疗SAID中的作用与PE相当,并发症和风险较小,治疗更有保障。

Objective To compare the effect of plasma exchange （PE） and doublefiltration plasmapheresis （DFPP） in the treatment of severe autoimmune disease （SAID）. Methods Twenty-seven patients with SAID were divided into PE group （10 cases） and DFPP group （17 cases） on the basis of different treatments. Therapeutic effects, complications, charges, hospitalization time and laboratory indexes were compared. Results In the PE group, the patients received 2.2 times treatment for 42.5 d and spent 39.5 thousand yuan in average, while in the DFPP group, the 17 cases received 2.88 times treatment for 41.94 d and spent 49.9 thousand yuan in average. Therapeutic effects were similar between the two groups. Occurrence of complications in DFPP group was less than PE group （P〈0.05）. The laboratory indexes changed slightly before and after PE except serum natrium. After DFPP, leukocyte and hemoglobin significantly increased, while albumin, globulin, immunoglobulin A （IgA）, IgG, IgM and C3 decreased markedly （all P〈0.05）. The platelet, serum potassium, serum natrium, creatinine, urea nitrogen and GPT showed no obvious change （all P〉0.05）. Conclusion DFPP, with the similar effect as PE, has less complications and lower risks in the treatment of SAID.