膜式血浆分离器血浆置换联合激素及免疫抑制剂治疗血栓性血小板减少性紫癜的疗效观察

Effect of plasma exchange with membrane plasma separator combined with glucocorticoids and immunosuppressive agents on thrombotic thrombocytopenic purpura

目的观察膜式血浆分离器行血浆置换(PE)联合激素及免疫抑制剂治疗,对血栓性血小板减少性紫癜(TTP)的疗效。方法选取2013年1月-2014年2月在中南大学湘雅医院确诊为TTP并接受PE联合激素及免疫抑制剂治疗的住院患者9例,观察PE治疗前后患者临床症状及各项实验室指标的变化。结果 8例患者存活(5例完全缓解、3例好转),1例患者(原发性TTP合并多器官功能衰竭)PE 1次后死亡。PE治疗后患者神经系统症状有不同程度减轻,体温恢复正常;尿素氮(BUN)、血肌酐(Scr)无明显变化;血红蛋白(Hb)、血小板计数(Plt)较治疗前升高(P<0.01);乳酸脱氢酶(LDH)、间接胆红素(IBIL)较治疗前降低(P<0.01)。结论膜式血浆分离器行PE联合激素及免疫抑制剂治疗对TTP患者疗效明显。

[Objective] To investigate the effect of plasma exchange with membrane plasma separator combined with glucocorticoids and immunosuppressive agents on thrombotic thrombocytopenic purpura （TIP）. [Methods] Nine patients with TIP, treated with plasma exchange combined with glucocorticoids and immuno- suppressive agents in Xiangya Hospital from January 2013 to February 2014, were studied. The main clinical and laboratory data before and after the treatment were analyzed. [Results] Eight patients survived （five at- tained a complete remission, three improved）, and one patient （diagnosed as primary TFP with multiple organ failure） died after one plasma exchange. Neurological symptoms of the patients abated in various degrees and body temperature returned to normal after the treatment, hemoglobin level and plate count elevated （P〈 0.01）; while lactic dehydrogenase （LDH） activity and indirect bilirubin （IBIL） concentration decreased （P〈 0.01）. Blood urea nitrogen and serum creatinine concentration had no significant change after the treatment. [ Conclusion] Plasma exchange with membrane plasma separator combined with glucocorticoids and immunosuppressive a- gents is an effective treatment for TFP.