全血浆置换和双重滤过血浆置换治疗的技术特点与相关不良事件关系

Relationship between complications and technical characteristics in treatment of double filtration plasma exchange and total plasma exchange

目的比较全血浆置换(TPE)与双重滤过血浆置换(DFPP)治疗的技术特点及相关并发症。方法选择2018年3月至2019年10月在北京大学国际医院血液净化中心接受TPE或DFPP治疗的患者37例,其中男性16例,女性21例;年龄15~82岁,平均年龄48.45岁;系统性红斑狼疮11例,血栓性微血管病4例,抗中性粒细胞胞浆抗体相关性小血管炎8例,溶血性尿毒症综合征3例,肝功能衰竭3例,多发性骨髓瘤2例,肾移植术后2例,其他4例(血小板减少性紫癜1例,急性淋巴细胞性白血病1例,难治性溶血性贫血1例,高脂血症1例)。按治疗方法分为TPE组(23例)和DFPP组(14例)。比较两组治疗中的技术参数,包括体外循环血泵流速(v_(B))、治疗时间(t)、补充血浆速度(v_(AP))和补浆(AP)量、分离血浆速度(v_(SP))和分浆(SP)量、废弃血浆速度(v_(WP))和弃浆(WP)量,统计治疗相关不良事件(AE)发生率。结果DFPP组治疗的vB、t、v_(SP)、SP量显著高于TPE组(vB:0.192 L/min±0.026 L/min vs 0.164 L/min±0.022 L/min;t=3.601,P=0.001。t:2.328 h±0.467 h vs 1.842 h±0.282 h;t=3.962,P=0.000。VSP:2.151 L/h±0.236 L/h vs 1.837 L/h±0.265 L/h;t=3.636,P=0.001。SP量:4.667 L±0.790 L vs 3.355 L±0.551 L;t=5.953,P=0.000),而v_(AP)、AP量、v_(WP)、WP量显著低于TPE组(v_(AP):0.328 L/h±0.221 L/h vs 1.837 L/h±0.265 L/h;t=-17.162,P=0.000。AP量:0.757 L±0.357 L vs 3.355 L±0.551 L;t=-15.701,P=0.000。v_(WP):0.393 L/h±0.208 L/h vs 1.837 L/h±0.265 L/h;t=-17.331,P=0.000。WP量:0.791 L±0.310 L vs 3.355 L±0.551 L;t=-15.886,P=0.000)。TPE组治疗相关AE显著高于DFPP组(14.29%vs 3.33%;χ^(2)=4.874,P=0.030),且与血液输注相关。结论与TPE相比,DFPP可有效节约血浆制品并减少因血制品输注造成的相关AE。

Objective To compare plasma exchange(TPE)and double filtration plasmapheresis(DFPP)technical characteristics and related complications treatment.Methods From May 2018 to October 2019,a total of 37 patients performed TPE or DFPP were enrolled,which included 16 males and 21 females,aged 15-82 years old with mean age of 48.45 years old.The primary diseases included 11 cases of system lupus erythematosus,4 of thrombotic microangiopathy,8 of anti-neutrophil cytoplasmic antibody associated vasculitis,3 of hemolytic uremic syndrome,3 of liver failure,2 of multiple myeloma,2 of kidney transplant,1 of thrombocytopenic purpura,1 of acute lymphoblastic leukemia,1 of refractory hemolytic anemia and 1 of hyperlipidemia,respectively.All of them were divided into TPE group(n=23)and DFPP group(n=14)by treatment method.The treatment technical parameters,which included extracorporeal circulation velocity of blood(vB),treatment time(t),added plasma(AP)speed(v_(AP))and AP volume,separated plasma(SP)speed(v_(SP))and SP volume,waste plasma(WP)speed(v_(WP))and WP volume between 2 groups were compared,and incidence of adverse events(AE)was calculated.Results The vB,t,v_(SP),SP volume in DFPP group was significantly higher than those in TPE group(vB:0.192 L/min±0.026 L/min vs 0.164 L/min±0.022 L/min;t=3.601,P=0.001.t:2.328 h±0.467 h vs 1.842 h±0.282 h;t=3.962,P=0.000.v_(SP):2.151 L/h±0.236 L/h vs1.837 L/h±0.265 L/h;t=3.636,P=0.001.SP volume:4.667 L±0.790 L vs 3.355 L±0.551 L;t=5.953,P=0.000),while v_(AP),AP volume,v_(WP),WP volume was significantly lower than those in TPE group(v_(AP):0.328 L/h±0.221 L/h vs1.837 L/h±0.265 L/h;t=-17.162,P=0.000.AP volume:0.757 L±0.357 L vs 3.355 L±0.551 L;t=-15.701,P=0.000.v_(WP):0.393 L/h±0.208 L/h vs 1.837 L/h±0.265 L/h;t=-17.331,P=0.000.WP volume:0.791 L±0.310 L vs3.355 L±0.551 L;t=-15.886,P=0.000).The AE related TPE treatment was significantly higher than that of DFPP(14.29%vs 3.33%;χ^(2)=4.874,P=0.030),and related to blood transfusion.Conclusion It is demonstrated that DFPP is more effective than TPE in saving blood products and reducing AE related to blood product transfusion.