单次单重膜式血浆置换对血常规及生化指标影响的前瞻性研究

TThe effect of single therapeutic plasma exchange via membrane filtration on hematocytes and electrolytes

目的膜式血浆置换是一种有效的特殊血液净化方式,但是单次单重膜式血浆置换对血常规及主要生化指标的影响的相关研究有限。方法前瞻性分析我院21例患者共40次血浆置换,置换前后抽血检测血常规及生化指标,并进行前后对比分析。结果置换后白细胞总数无明显变化,但淋巴细胞计数下降24.41%[(0.70±0.52)×10~9/L比(0.42±0.33)×10~9/L,t=3.645,P=0.001]。血浆用量(β=-0.329,P=0.013)和总置换量(β=0.576,P=0.001)是淋巴细胞计数变化的独立影响因素。血红蛋白水平、血小板计数分别下降6.92%[(87.21±10.72)g/L比(80.92±10.61)g/L,t=5.222,P<0.001]、12.83%[(167.63±76.69)×109/L比(149.13±72.47)×10~9/L,t=5.346,P<0.001]。血红蛋白水平下降的幅度与低分子肝素用量呈负相关(r=-0.330,P=0.043)。血小板计数下降的幅度与管路凝血程度成正相关(r=0.388,P=0.016),与低分子肝素用量呈负相关(r=-0.425,P=0.008)。经过多因素回归分析,管路凝血是血小板计数下降的独立影响因素(β=-14.562,P=0.008)。血清总钙水平下降2.84%[(2.16±0.14)mmol/L比(2.09±0.18)mmol/L,t=2.289,P=0.029],与白蛋白用量成负相关(r=-0.672,P<0.001)。多因素回归分析显示置换前后血钙水平变化的影响因素是白蛋白用量(β=-0.003,P<0.001)。结论单重膜式血浆置换是一种安全的血液净化方式,无明显不良反应。充分抗凝,避免管路凝血可以减轻血小板计数的下降。为了减少总钙水平的下降,应当根据白蛋白用量补充钙剂。

Objective Therapeutic plasma exchange （TPE） is an effective and specific blood purifica- tion. However, studies about the single plasma exchange on hematocytes and electrolytes are limited. Meth- ods Forty TPE sessions from 21 patients were enrolled in this prospective study. Hematocytes and electro- lytes including albumin, calcium and potassium were measured before and after the TPE sessions. Results No difference in white blood cell count was found after TPE sessions, but lymphocyte counts decreased by 24.41% （0.70±0.52× 10-9/L vs. 0.42±0.33×10-9/L, t=3.645, P=0.001）. Plasma volume for exchange （β=-0.329, P= 0.013 ） and total exchange volume （β=0.576, P=0.001） were the two independent factors for the change of lym- phocyte count. Hemoglobin and platelet count decreased by 6.92% （87.21±10.72 g/L vs. 80.92±10.61 g/L, t=- 5.222, P〈0.001） and 12.83% （167.63±76.69×10-9/L vs. 149.13±72.47×10-9/L, t=5.346, P〈0.001）, respectively. The reduction of hemoglobin was negatively correlated with the dosage of low molecular weight heparin （r=-0.330, P=-0.043）. The reduction of platelet count was positively correlated with the coagulation in blood cir- cuit （r=0.388, P=0.016）, and was negatively correlated with the dosage of low molecular weight heparin （r=- 0.425, P=0.008）. Multivariate regression demonstrated that coagulation in blood circuit was the independent factor for reduction of platelet count （β=-14.562, P=0.008）. Serum calcium decreased by 2.84% （2.164-0.14 mmol/L vs. 2.09±0.18 mmol/L, t=-2.289, P=-0.029）, and was negatively correlated with the albumin volume used （r=-0.672, P〈0.001）. Multivariate regression revealed that albumin volume used was the independent factor for reduction of calcium （β=-0.003, P〈0.001）. Conelusions TPE via membrane filtration is a safe approach for blood purification. Mild reduction in hemoglobin, platelet and calcium were found after the ses- sions. Sufficient anticoagulation and supplement of calcium are necessary.