血浆置换治疗在重症肌无力患者中的应用——附57例临床疗效分析

Using Plasmaphoresis in MG Patients 57 Cases Report

目的确定血浆置换（ＰＰ）治疗重症肌无力（ＭＧ）的起效时间、疗效，评价其疗效是否与降低血中乙酰胆碱受体抗体（ＡＣｈＲＡｂ）有关。方法ＰＰ第１周隔日１次，共３次，以后每周１次。用健康人血浆及血浆代用品进行ＰＰ，一般每次２０００ｍＬ（即７０６代血浆５００ｍＬ，血浆１５００ｍＬ），置换当日及置换后每日于固定时间根据临床绝对记分法进行评分，同时每日晨取血查ＡＣｈＲＡｂ。结果痊愈、基本痊愈、显效、好转和无效分别为１、４、２３、２２和６例，总有效率８９．４７％。共有３５人、５２次在置换中出现不同程度副作用，包括口周麻木、四肢麻木、荨麻疹、寒战、发热和低血压等，经对症处理后好转。结论ＰＰ起效迅速，在肌无力危象抢救中有重要价值，但单独使用疗效不持久，应用得当可减少副作用。

Objective To determine the therapeutic effect of plasmaphoresis (PP) and its starting time in treating patients with myasthenia gravis (MG),and confirm the correlation between the therapeutic efficacy and the decreasing of serum level of anti acetylcholine receptor antibodies (AChRAb). Methods Fifty seven patients with MG were treated with PP. and divided according to modified ossermann classification into ⅡA,ⅡB,Ⅲ and Ⅳ groups with case numbers 2,18,18 and 19 respectively. During the first week,PP was performed every other day,total 3 times;then once a week.Plasma from healthy donors and plasma substitute were used,2 000 mL(500 mL of 706 plasma substitute and 1 500 mL plasma)for each exchange.Physical examination for absolute clinical score and withdrawal blood for AChRAb determination were done early in the morning on day 0 of PP and everyday since then. Result Number of patient in therapeutic assess grades cure,essential cure,remarked effect,effect and no effect was 1,4,23,22 and 6 respectively,total effective rate is 89 47%.Side effects occurred in 35 patients with 52 times of PP,including perioral numbness 8 cases 11 times,numbness of extremities 4 cases 6 times,urticaria 15 cases 24 times,shiver 6 cases 9 times,fever 1 cases 1 time,hypotension 1 case 1 time.All of the side effects disappeared after symptomatic treatment. Conclusion Plasmapheresis was essentially valuable in the emergent treatment of MG crises .The effect was dramatic,but not persistent.If it was applied appropriately,its side effects was mild and avoidable.