膜式血浆置换153例次的临床应用分析

Clinical Application of 153 Times Membrane Plasmapheresis

目的 :总结 15 3例次膜式血浆置换 (PP)临床治疗经验 ,比较单、双滤法PP清除免疫球蛋白及补体C3 (C3 )的效果。方法 :6 2例患者 ,行 77例次单滤法、76例次双滤法 ,观察治疗前后临床症状、体征改善及副作用 ,比较IgG、IgA、IgM、C3 、蛋白电泳等变化。结果 :PP治疗后临床症状明显改善 ,双滤法前后IgG分别为 :(2 2 .0 2± 15 .6 2 )、(11.40± 8.12 ) g/L(P <0 .0 0 1) ,IgM分别为 :(12 74.39± 816 .6 8)、(781.6 7± 5 6 9.6 )mg/L(P <0 .0 0 5 ) ,副作用发生率 10 .45 % ,单滤法为 18.18% ,双滤法为2 .6 3%。结论 :膜分离法PP临床应用安全、有效 ;双滤法也能有效清除IgG。

Objective:To summarize clinical data of membrane plasmapheresis(PP) and compare removal effect of IgG, IgA, IgM, C 3, C 4,CH 50 of single filtration PP as double filtration PP. Methods:153 treatments of PP (single 77, double 76) were performed on 62 patients who suffered from progressive systemic sclerosis(in 18), chronic hemodialysis(in 13), SLE(in 5), myasthenia gravis (in 5), hyperviscosity syndrome(in 4), acute Guillain-Barre syndrome(in 9). Serum and filtrate levels of IgG, IgA, IgM, C 3, C 4, CH 50 and protein eletrophoresis were measured before and after a single course PP. Results:Serum levels of IgG, IgA, IgM, C 3, C 4,Ch 50 after double filtration PP were signifficantly reduced as compared with before double filtration PP (P<0.005). The same time, serum levels of C 3 after single filtration PP was not signifficantly reduced (P>0.05). Incidence of side effects was 10.45% (single filtration PP: 18.18%, double filtration PP:2.63%). Conclusion: PP was more safety and effective therapeutics that removing of immunoglobutin. The removation of IgG with double filtration PP was more effective.