双重滤过血浆置换与静脉注射免疫球蛋白治疗重型吉兰-巴雷综合征的疗效评价

Efficacy of Double Filtration Plasmapheresis with Intravenous Immunoglobulin in Treating Severe Guillain-Barre Syndrome

目的探讨双重滤过血浆置换(DFPP)与静脉注射免疫球蛋白(IVIG)治疗重型吉兰-巴雷综合征(GBS)的疗效。方法将45例重型GBS患者,按照治疗方式不同分为DFPP组(n=22)和IVIG组(n=23),两组在接受常规药物治疗的同时,DFPP组联用双重滤过血浆置换,IVIG组联用静脉注射免疫球蛋白,通过神经疾病残疾评分(NDS)和Hughes评分观察两组治疗前后神经功能改善程度。结果两组NDS评分和Hughes评分在治疗2周、4周后与治疗前比较,差异均有统计学意义(P<0.05),DFPP组在治疗2周后Hughes评分和NDS(颅神经)评分低于IVIG组,差异有统计学意义(P<0.05),DFPP组在治疗4周后Hughes评分和NDS的4组评分均低于IVIG组,差异均有统计学意义(P<0.05)。结论 DFPP和IVIG均是治疗重型GBS较为有效的方法,可降低患者神经残疾程度和提高生存质量,其中DFPP的疗效更为显著,在神经修复速度上更显优势,尤其是在颅神经的修复方面。

Objective To observe the curative effects of double filtration plasmapheresis（DFPP）with intravenous immunoglobulin（IVIG）in the severe Guillain-Barre Syndrome（GBS）.Methods 45 cases of severe GBS patients,on the basis of different methods of treatment,were divided into DEPP group（n=22）and IVIG group（n=23）.On top of conventional treatment,DEPP group was added double filtration plasmapheresis and IVIG group was combined with intravenous immunoglobulin.Neural function improvement was observed through neurological disability scores（NDS）and Hughes scores before and after treatment.Results There were statistically significant differences in both groups in terms of the NDS scores and Hughes scores after 2weeks and 4weeks after treatment and before treatment（P〈0.05）.The Hughes and NDS（cranial nerve）scores of DEPP group after 2 weeks of treatment were lower than those of IVIG group,the differences were statistically significant（P〈0.05）.The Hughes and four groups of NDS scores of DEPP group after 4weeks of treatment were lower than those of IVIG group,the differences were statistically significant（P〈0.05）.Conclusion DFPP and IVIG are both effective way of treatment of severe GBS and can both reduce neurological disability and improve quality of life while DFPP is more effective in terms of the speed of neural repair especially in the repair of cranial nerves.