淋巴血浆置换治疗重症皮肌炎的临床疗效及对患者血清辅助性T细胞与T细胞亚群平衡的影响

The effect of lymphatic plasma exchange in the treatment of dermatomyositis gravis and its effect on T helper cell,T cell subpopulations balance

目的分析淋巴血浆置换治疗重症皮肌炎(DM)疗效及对患者血清辅助性T细胞(Th)与T细胞亚群平衡的影响。方法选取2020年12月至2021年12月萍乡市人民医院收治的116例重症DM患者作为研究对象,采用随机数字表法分为对照组与观察组,每组58例。对照组采用静脉注射免疫球蛋白(IVIG)治疗,观察组采用淋巴血浆置换治疗,比较两组临床疗效、实验室指标[红细胞沉降率(ESR)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)]、Th及T细胞亚群水平、不良反应发生情况、血常规与肾功能[血肌酐(SCr)、WBC、血红蛋白(Hb)、血小板计数(PLT)]。结果观察组治疗总有效率为89.66%,高于对照组的74.14%,差异有统计学意义(P<0.05)。治疗后,两组ESR及CK、LDH、AST水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组Th1水平、Th1/Th2均低于治疗前,Th2、Th17、CD4^(+)、CD8^(+)水平均高于治疗前,且观察组Th1水平、Th1/Th2均低于对照组,Th2、Th17、CD4^(+)、CD8^(+)水平均高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。两组治疗前后组间及组内WBC、PLT及SCr、Hb水平比较差异无统计学意义。结论淋巴血浆置换治疗重症DM疗效确切,可纠正患者外周血Th1/Th2失衡情况,调节Th、T细胞亚群平衡,且不良反应少,值得临床推广应用。

Objective To analyze the efficacy of lymphatic plasma exchange in the treatment of dermatomyositis(DM)gravis and its effect on T helper cell(Th),T cell subpopulations balance.Methods 116 patients with severe DM treated in Pingxiang People's Hospital from December 2020 to December 2021 were selected as the study subjects,and they were divided into the control group and the observation group according to the random number table method,with 58 cases in each group.The control group was treated with intravenous immunoglobulin(IVIG),the observation group was treated with lymphatic plasma exchange,the clinical efficacy,laboratory indexes(erythrocyte sedimentation rate[ESR],creatine kinase[CK],lactate dehydrogenase[LDH],aspartate aminotransferase[AST]),Th and T cell subsets,the occurrence of adverse reactions and blood routine and renal function(serum creatinine[SCr],WBC,hemoglobin[Hb],platelet count[PLT])were compared between the two groups.Results The total effective rate in the observation group was 89.66%,which was higher than 74.14%in the control group,and the difference was statistically significant(P<0.05).After treatment,ESR,CK,LDH and AST levels of the two groups were lower than before treatment,and observation group was lower than control group,the differences were statistically significant(P<0.05).After treatment,the levels of Th1 and Th1/Th2 of the two groups were lower than before treatment,while the levels of Th2,Th17 and CD4^(+)and CD8^(+)were higher than before treatment,and the levels of Th1 and Th1/Th2 in the observation group were lower than those in the control group,and the levels of Th2,Th17,CD4^(+),CD8^(+)were higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.There were no significant differences in WBC,PLT,SCr and Hb levels between and within the two groups before and after treatment.Conclusion Lymphatic plasma exchange therapy for patients with dermatomyositis gravis can achieve good therapeutic effect,it can correct the imbalance of Th,T cell subpopulations in peripheral blood,regulate the balance of T lymphocyte subsets,and has few adverse reactions,it is worthy of clinical promotion and application.