血浆置换治疗血栓性血小板减少性紫癜效果观察

Effect of Plasma Exchange in the Treatment of Thrombotic Thrombocytopenic Purpura

目的观察血浆置换治疗血栓性血小板减少性紫癜(TTP)的临床效果。方法收集辽河油田总医院2015—2018年收治的TTP患者29例,全部患者均为经糖皮质激素和(或)免疫抑制剂治疗1个月以上无效,给予血浆置换3次/周,选择治疗前及治疗1周后作为观察节点,比较血常规和免疫检查结果变化情况。结果患者治疗前后白细胞、血红蛋白、红细胞水平差异无统计学意义(P>0.05);治疗后血小板水平明显升高,与治疗前相比差异有统计学意义(P<0.05)。患者治疗后血小板相关免疫球蛋白A、血小板相关免疫球蛋白G、血小板相关免疫球蛋白M、血小板相关C3及循环免疫复合物水平均较治疗前明显降低,与治疗前相比差异有统计学意义(P<O.05)。结论血浆置换可以有效降低血栓性血小板减少性紫癜患者外周血中的血小板相关免疫球蛋白、补体和循环免疫复合物水平,并明显提高血小板水平,而对其他血常规观察指标无明显影响。

Objective To observe the clinical effect of plasma exchange in the treatment of thrombotic thrombocytopenic purpura.Methods Twenty-nine patients with TTP admitted to our hospital from 2015 to 2018 were collected.All patients had no response after treating with glucocorticoid and/or immunosuppressive agents for more than one month.Plasma exchange was performed three times a week.Blood routine examination and immunological test results were compared before and after one week treatment.Results There was no significant difference in WBC,HB and RBC levels before and after treatment(P>0.05);PLT levels after treatment were significantly higher than before treatment(P<0.05).After treatment,the levels of PA-IgA,PA-IgG,PA-IgM,PA-C3 and CIC were significantly lower than those before treatment-(P<0.05).Conclusion Plasma exchange can effectively reduce the levels of circulating platelet-associated immunoglobulin,complement and circulating immune complex in patients with thrombotic thrombocytopenic purpura,and sigiaificantly improve the platelet level,but has no significant effect on other blood routine indexes.