改良血浆置换术治疗血栓性血小板减少性紫癜的临床观察

Clinical observation of modified plasma exchange in treatment of thrombotic thrombocytopenic purpura

目的:研究改良血浆置换术治疗血栓性血小板减少性紫癜(TTP)的临床效果。方法:选取2013-04—2018-11中山大学附属第八医院接受改良血浆置换术治疗的TTP患者9例为观察对象。采用生理盐水、4%白蛋白生理盐水混合溶液和新鲜冰冻血浆作为置换液,其中血浆用量20ml/kg,且有1/3的血浆在术后直接回输至患者体内,共进行32次血浆置换术治疗。另选同期治疗的9例采用常规新鲜冰冻血浆置换术的TTP患者为对照组。分别比较2组临床疗效,治疗前后患者凝血功能指标水平,血小板计数、血红蛋白水平,血小板相关抗体水平,不良反应发生情况。结果:2组患者的疗效相比,差异无统计学意义(P>0.05)。治疗前后患者血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆凝血酶时间(TT)、纤维蛋白原(FB)水平比较均不明显,差异均无统计学意义(均P>0.05)。治疗后患者血小板计数、血红蛋白水平相比治疗前较高,差异有统计学意义(均P<0.05)。治疗后患者PAIgG、PAIgM、PAIgA水平相比治疗前较低,差异均有统计学意义(均P<0.05)。9例患者治疗后均未发生低血容量、过敏、枸橼酸盐中毒以及出血等不良反应。结论:改良血浆置换术治疗TTP的效果较佳,可显著改善患者的血小板计数、血红蛋白水平,下调血小板相关抗体水平,且显著降低了不良反应发生风险,具有较好的安全性,值得临床推广应用。

Objective:To study and analyze the clinical effect of modified plasma exchange for the treatment of thrombotic thrombocytopenic purpura(TTP).Method:From April 2013 to November 2018,9 patients with TTP receiving modified plasma exchange in the Eighth Affiliated Hospital of Zhongshan University were selected for observation.Normal saline,4%white saline mixed solution and fresh frozen plasma were used as exchange solution,in which the amount of plasma was 20 ml/kg,and 1/3 of the plasma was directly returned to the patient after the surgery,a total of 32 times of plasma replacement therapy was performed.9 patients with TTP treated in our hospital with routine fresh frozen plasma exchange at the same time were recorded as the control group.The clinical efficacy between two groups was compared.Blood coagulation function,platelet count,hemoglobin level,platelet-associated antibody level and adverse events were compared before and after treatment.Result:There was no significant difference in curative effect between the two groups(P>0.05).Before and after treatment,there were no significant differences in plasma prothrombin time(PT),activated partial thrombin time(APTT),plasma thrombin time(TT)and fibrinogen(FB)levels(all P>0.05).The platelet count and hemoglobin levels of the patients after treatment were higher than those before treatment,and the differences were statistically significant(both P<0.05).The levels of PAIgG,PAIgM and PAIgA were lower after treatment than those before treatment,and the differences were statistically significant(allP<0.05).No adverse events such as hypovolemic reaction,anaphylaxis,citrate poisoning or bleeding occurred in 9 patients after treatment.Conclusion:Modified plasma exchange was effective in the treatment of TTP,which could significantly improve the patient’s platelet count and hemoglobin level,down-regulate the platelet related antibody level,and significantly reduce the risk of adverse events.It might have good safety and be worthy of clinical application.