血浆置换治疗35例重症系统性红斑狼疮的临床疗效

Clinical efficacy of Plasma exchange treatment for 35 patients with severe systemic lupus erythematosus

目的:探讨血浆置换(PE)术治疗35例重症系统性红斑狼疮的疗效。方法:采用新鲜血浆和生理盐水及706代血浆组成的置换液治疗35例重症系统性红斑狼疮患者,并辅助用一些常用药物进行治疗。以泼尼松、环磷酰胺常规药物治疗25例重症系统性红斑狼疮患者作对照。分析2组患者治疗前、后血清中ANA、dsD-NA、ESR、C3、CRP、BUN、Cr、IgG、IgA、IgM指标的变化及治疗有效率。结果:重症系统性红斑狼疮患者经PE治疗后,血清中的IgG、IgA、IgM、ANA、dsDNA、ESR、C3、CRP、BUN、Cr较血浆置换前明显降低,差异有统计学意义,患者临床症状明显改善;PE组的总有效率为97.1%,对照组的总有效率为64.0%,差异有统计学意义(P<0.05)。102次PE过程中发生7次不良反应,对症处理后好转。结论:PE治疗重症系统性红斑狼疮疗效肯定,起效快,短期疗效显著,安全性好。

Objective： To discuss the clinical effect of plasma exchange treatment for 35 patients with severe systemic lupus erythematosus. Method： 35 patients with severe systemic lupus erythematosus were treated using plasma exchange（PE） with replacement fluid consisted of fresh plasma, saline and 706 artificial plasma, and re ceived some common medicine treatment simultaneously. 25 patients with severe systemic lupus erythematosus who received common medicine treatment of prednisone and cyclophosphamide were taken as controls. The chan ges of serum ANA, dsDNA, ESR, C3 , CRP, BUN, Cr, IgG, IgA and IgM, as well as treatment efficiency, he fore and after treatment of two groups were analyzed. Result： In PE group after treatment the serum IgG, IgA, IgM, ANA, dsDNA, ESR, C3, CRP, BUN and Cr were significantly lower than those before treatment, which difference was statistically significant. The clinical symptoms of patients were significantly improved. The total ef feetive rate of PE group and control group was 97.1% and 64%, respectively, which difference was statistically significant（P〈0.05）. Among the courses of 102 PEs there were 7 adverse reactions（3 fever, 2 allergic reactions and 2 hypocalcemia） ,with the adverse event rate of 6.7%. The symptoms of adverse reactions were mild, and im proved after treatment. Conclusion ： Plasma exchange would be an effective treatment for severe systemic lupus er- ythematosus, with the advantages of quick-effective, significant short-term effect is and good safety.