血浆置换治疗血栓性血小板减少性紫癜的疗效观察

Observation of Plasma Exchange in the Treatment of Thrombotic Thrombocytopenic Purpura

目的 探讨血浆置换（PE）对血栓性血小板减少性紫癜（TTP）的疗效及病情转归。方法 16例被确诊为TTP的患者经过PE后,结合糖皮质激素治疗后进行总体分析。结果 TTP特点为无征兆急性发作,最初症状为皮肤出血。临床以广泛的血小板减少、微血管血栓生成、神经精神异常为特征的“三联征”患者比例为93.8%,同时伴有发热和肾病症状的“五联征”患者比例为63.5%。16例患者完成3~9次血浆置换,4例治疗无效死亡,12例治疗后血小板（PLT）、血红蛋白（Hb）上升,总胆红素（IBIL）、破碎红细胞、镜下血尿、蛋白尿、乳酸脱氢酶（LDH）降低,结果有统计学意义。结论 PE结合糖皮质激素发能有效缓解TTP症状及改善患者预后。如患者复发,可考虑细胞毒类及烷化剂等免疫抑制剂治疗。

Objective To explore the effect of plasma exchange（ PE） for thrombotic thrombocytopenic purpura（ TTP）. Methods All 16 clinical treatment of PE combined with glucocorticoid retrospectively analyzed. Results TTP is acute onset and has dermatorrhagia plus neurological abnormality initial symptoms. The patients with triad symptoms of thrombocytopenia,microangiopathic hemolytic hemolytic anemia and neurological abnormalityaccouted for 93. 8%,and patients with pentad symptoms accounted for 63. 5%. 4patients died during PE. The PLT、Hb、IBIL、BUN、and LDH were significantly improved for the other 12 patients after 3 ~ 9 times PE. Conclusion PE combined with glucocorticoid can significantly improve the prognosis of TTP patients,and it be taken as soon as possible,but immunosuppressive therapy with cytotoxic and alkylating agents should be added for relapsed patients.