双重血浆置换与血浆吸附治疗自身免疫性疾病的比较研究

Comparative study of double-filtration plasmapheresis and plasma adsorption in treatment of autoimmune diseases

目的比较双重血浆置换(DFPP)和血浆吸附(PA)两种血浆净化方式治疗自身免疫性疾病的差异。方法 30例自身免疫性疾病患者分为两组,分别采用DFPP和PA进行治疗,对单次治疗前后IgA、IgG、IgM、C3、C4指标及血液净化相关并发症情况进行比较。结果单次DFPP治疗后血清IgA、IgG、IgM、C3、C4水平下降比率分别为(44.2±14.0)%、(45.2±6.3)%、(49.3±13.1)%、(46.2±10.3)%、(44.0±11.6)%,单次PA治疗后血清IgA、IgG、IgM、C3、C4水平下降比率分别为(42.4±8.5)%、(42.9±6.2)%、(46.1±7.2)%、(42.5±6.5)%、(48.3±9.6)%;单次DFPP与PA在相同治疗量下对血清IgA、IgG、IgM、C3、C4的清除效果差异无统计学意义,但PA的血液净化相关并发症发生率比DFPP更低(P<0.05)。结论自身免疫性疾病行DFPP及PA治疗均可以有效地清除血清免疫球蛋白和补体且两者清除效果相当,但PA治疗的并发症发生率更低。

Objective To compare the efficacy of double-filtration plasmapheresis（DFPP） and plasma absorption（PA） in the treatment of autoimmune diseases.Methods Thirty patients with autoimmune diseases were divided into two groups,in which they were treated with DFPP and PA respectively.The serum IgA,IgG,IgM,C3 and C4 levels and blood purification associated complications were compared.Results The reduction of IgA,IgG,IgM,C3 and C4 after DFPP were（44.2±14.0）%,（45.2±6.3）%,（49.3±13.1）%,（46.2±10.3）% and（44.0±11.6）%,respectively;and were（42.4±8.5）%,（42.9±6.2）%,（46.1±7.2）%,（42.5±6.5）% and（48.3±9.6）%,respectively after PA.There was no significant difference in the clearance rates of IgA,IgG,IgM,C3 or C4 between DFPP and PA with same dosage.However,significantly lower incidence of blood purification associated complications was revealed in PA treatment than DFPP（P〈0.05）.Conclusion It is suggested that DFPP and PA can effectively remove serum immunoglobulins and complements in treating autoimmune diseases,with equal clearance rates,but PA treatment guarantees lower incidence of blood purification associated complications.