血浆置换治疗重症类风湿性关节炎临床疗效分析

Analysis on clinical efficacy of plasma exchange in treatment of severe rheumatoid arthritis

目的观察血浆置换(PE)治疗重症类风湿性关节炎(RA)临床疗效。方法采用0.9%NaCl、706代血浆、病毒灭活血浆组成的置换液治疗52例重症RA患者,并与常规药物治疗45例重症RA患者组进行比较,分析两组患者治疗前后血清中IgG、IgA、IgM、C3、C4、C1q、CIC、CRP、ESR、RF共10项实验室指标的变化,并观察和统计患者血浆置换过程中的不良反应情况。结果重症RA患者经血浆置换后,血清中的IgG、IgA、IgM、C3、C4、C1q、CIC、CRP、ESR、RF较血浆置换前明显降低(P<0.05),患者临床症状明显改善;药物对照组治疗后,血清中仅有IgG、C1q、RF共3项指标较治疗前明显降低(P<0.05)。血浆置换组患者的总有效率为96.2%,高于药物治疗组患者75.5%的总有效率(P<0.01)。208次血浆置换过程中发生15次不良反应(发热反应8次,过敏反应4次,低钙血症3次),不良反应发生率为7.2%,症状均较轻,对症处理后好转。结论血浆置换治疗重症RA的疗效肯定,安全性较好。

Objective To observe the treatment effect of plasma exchange on severe rheumatoid arthritis （RA）. Methods Trial group including 52 severe RA patients was treated by exchange fluid composed of0. 9% NaC1, Hetastarcb and virus-inactivated plasma. Control group including 45 severe RA patients was treated with routine therapy. Their laboratory parameters including IgG, IgA, IgM C3, C4, Clq, C1C, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR） and rheumatoid factor （RF） were observed before and after treatment. Meanwhile, adverse response was explored during plasma exchange. Results All the laborato- ry parameters were significantly decreased after plasma exchange in the trial group （ P 〈 0.05 ） , and, the clinical conditions were improved significantly. In the control group, only IgG 、 C1 q and RF were significantly decreased after treatment. There was a signifi- cant difference in total effect （96.2% vs 75.5% ） between the two group （P 〈 0.01 ）. There were 15 adverse reactions during 208 times of plasma exchange including fever （8 times）, allergic reaction （4 times） and hypocalcemia （3 times）. The adverse re- sponse counted for 7.2%, and the mild symptoms were improved after symptomatic treatment. Conclusion It is indicated that plasma exchange is safe and has confirmed treatment effect on severe RA patients.