双重血浆置换术治疗结缔组织病的疗效及安全性观察

Efficacy and safety of double filtration plasmaphersis in the treatment of connective tissue diseases

目的 观察双重血浆置换（DFPP）联合激素和免疫抑制剂对结缔组织病如类风湿关节炎（RA）、系统性红斑狼疮（SLE）、炎性肌病（IM）的疗效及安全性.方法 选取RA患者28例,SLE患者52例,IM患者24例,每例患者均在激素及免疫抑制剂治疗的基础上,行DFPP治疗2次,2次间隔时间为1周,分别对患者DFPP治疗前后的炎性指标及病情活动性的指标进行检测.结果 （1）RA患者DFPP治疗后IgM-类风湿因子（IgM-RF）、IgG-类风湿因子（IgG-RF）、红细胞沉降率（ESR）、C反应蛋白（CRP）的滴度及DAS28评分较治疗前明显下降,差异有统计学意义（P＜0.05）,IgA-类风湿因子（IgA-RF）和抗环瓜氨酸肽（CCP）抗体的滴度在治疗前后比较差异无统计学意义（P＞0.05）;（2）SLE患者DFPP治疗后的ESR、CRP、抗ds-DNA滴度及SLEDAI评分较治疗前明显下降,差异有统计学意义（P＜0.05）,补体C3、补体C4及24小时尿蛋白定量在治疗前后比较差异无统计学意义（P＞0.05）;（3）IM患者DFPP治疗后ESR、CRP、心肌酶的水平较治疗前明显下降,差异有统计学意义（P＜0.05）,肌红蛋白在治疗前后比较差异无统计学意义（P＞0.05）.结论 DFPP能够减轻RA患者的炎症反应,能够控制SLE疾病的活动,有效控制疾病的进展,使IM患者的肌酶迅速降低,在急性期能够迅速控制疾病的进展.

Objective To investigate the efficacy and safety of double filtration plasmaphersis （DFPP） combined with immunosuppressive agents in the treatment of connective tissue diseases,such as rheumatoid arthritis （RA）,systemic lupus erythematosus （SLE）,and inflammatory myopathy （IM）.Methods Upon with the therapy of steroid and immunosuppressive,104 patients（28 RA,52 SLE and 24 IM） received DFPP twice with one-week interval.Markers of inflammatory and disease activity were detected before and after DFFP treatment.Results After DFPP treatment：（1） In RA patients,the concentration of ESR,CRP,IgM-RF,IgG-RF and DAS28 were significantly decreased（P ＜ 0.05）and the levels of IgA-RF and anti-CCP did not change.（2）In SLE patients,ESR,CRP,antibody titer of ds-DNA and score of SLEDAI were significantly decreased（P ＜0.05） and the concentrations of complement protein C3 and C4,24-hour urine protein did not change（P ＞ 0.05）.（3） In IM patients,ESR,CRP and cardiac enzymes were significantly decreased （P ＜ 0.05） and myoglobin did not change （P ＞ 0.05）.Conclusion （1） DFPP can reduce the extent of inflammatary reaction in RA patients.It is a good ahernative therapy for patients irresponsible to steroid and immunosuppressive agents.（2） DFPP may slow down the progression of SLE,especially for controling SLE with active flares and manifestations.（3） DFPP can reduce the levels of cardiac enzymes in IM patients,especially for controling the development of acute IM.（4） No plasmapheresisrelated complications occurred in these cases.DFPP is a safe and well tolerated therapy for providing immediate relief in patients with connective tissue diseases.