双重血浆置换在临床危重症疾病18例的疗效观察

Therapeutic effect of double filtration plasmapheresis in treatment of critical illness:a report of 18 cases

目的观察双重血浆置换(DFPP)在两类临床危重症疾病中的疗效和安全性。方法回顾分析2011年1月至2013年12月在血液净化室进行DFPP治疗18例患者的临床资料,其中急性高脂血症性胰腺炎9例,重症自身免疫性疾病(SAID)9例(包括格林巴利综合征2例,重症肌无力1例,难治性类风湿关节炎2例,重症狼疮性肾炎2例,多发性肌炎重叠系统性硬化症1例,抗中性粒细胞胞浆抗体相关性血管炎1例)。结果 (1)18例患者共进行DFPP治疗27次,发生过敏反应2例次,低血压2例次,血浆分离器破膜1例次,经对症处理后均能完成治疗;(2)急性高脂血症性胰腺炎9例DFPP治疗后胆固醇、甘油三酯、白细胞计数、中性粒细胞、C-反应蛋白水平均较治疗前显著下降(P<0.05或P<0.01);8例单次DFPP治疗后腹部症状,体征缓解,1例重症患者死亡。(3)SAID 9例DFPP治疗后免疫球蛋白(Ig G、Ig A、Ig M、Ig E)、补体(C3、C4)、C-反应蛋白、血沉均较治疗前显著下降(P<0.05或P<0.01),3例患者因病情过重死亡。结论 DFPP是临床多种危重疾病的有效治疗方法,其机制可能与快速降低血浆中大分子致病因子(如脂蛋白、免疫球蛋白、补体、免疫复合物等)有关,可为相关危重疾病的进一步治疗创造机会。

Objective To observe the efficacy and safety of double filtration plasmapheresis（DFPP） in the treatment of two types critical illness.Methods The retrospective analysis was performed on clinical data of 18 patients with acute hyperlipidemic pancreatitis（9 case） or severe autoimmune diseases（SAID,including 2 cases of Guillain-Barrés syndrome,1case of myasthenia gravis,2 cases of refractory rheumatoid arthritis,2 cases of severe lupus nephritis,1 case of polymyositis overlapped with systemic sclerosis,1 case of ANCA associated vasculitis） who were treated by DFPP in blood purification room between January 2011 and December 2013.Results（1） The adverse effects in 27 times of DFPP treatment in 18 patients were seen in 2 case-times for allergic reactions,2 case-times for hypotension,1 case-time for plasma separator rupture,and the DFPP therapy can all be completed after symptomatic treatment.（2） In all the 9 cases of hyperlipidemic pancreatitis,the levels of cholesterols,triglycerides,white blood cell count,neutrophils and C-reactive protein after DFPP therapy decreased significantly（P 〈 0.05 or P 〈 0.01）;out of 9 cases of hyperlipidemic pancreatitis,8 patients,abdominal symptom and sign were relieved after a single DFPP treatment,and 1 critically ill patients died.（3） In all the 9 cases of SAID,the levels of immunoglobulin（Ig G,Ig A,Ig M,Ig E）,complement（C3,C4）,C-reactive protein and erythrocyte sedimentation rate after DFPP therapy decreased significantly（P 〈 0.05 or P 〈 0.01）.Three patients died from too serious illness condition.Conclusions DFPP is an effective treatment method for a variety of critical illness,and its mechanism is possibly associated with the rapid decrease of macromolecules causative factors（such as lipoproteins,immunoglobulin,complement,immune complexes,etc.） in plasma.DFPP can create opportunities for the further treatment of relative severe diseases.