Review of plasma exchange and rituximab for prevention of recurrent focal segmental glomerulosclerosis after a prior graft loss

BACKGROUND Focal segmental glomerulosclerosis(FSGS)often recurs after transplantation,leading to graft dysfunction and graft loss.Patients who have lost prior grafts due to recurrence are at particularly high risk of re-recurrence in subsequent grafts.Rituximab and plasma exchange have been used pre-emptively to prevent post-transplant recurrence.However,the efficacy of such preventative measures remains unclear.AIM To investigate the outcomes of preventative rituximab and plasma exchange for recurrent FSGS in transplant recipients after prior graft loss.METHODS We conducted a systematic review of 11 studies with 32 patients who had experienced prior graft loss due to post-transplant FSGS recurrence and were treated with either pre-emptive plasma exchange alone,rituximab alone,or a combination of both.RESULTS Overall,47%of the 32 patients experienced recurrence despite prophylactic treatment.Re-recurrence was seen in 25%(1/4)with pre-emptive rituximab alone,and 45%recurrence(9/20)with plasma exchange alone.Re-recurrence was noted in 63%with the use of combined plasma exchange and rituximab.CONCLUSION There is a paucity of available evidence in the literature to draw clear conclusions on the benefits of pre-emptive measures to prevent FSGS re-recurrence.The small sample sizes and variations in protocols call for larger and controlled studies to serve this patient population at high risk of recurrence and graft loss.

Efficacy of Rituximab Combined with Plasma Exchange in the Treatment of Thrombotic Thrombocytopenic Purpura(TTP)

Objective:To analyze the curative effect of rituximab combined with plasma exchange in the treatment of thrombotic thrombocytopenic purpura.Methods:70 patients with thrombotic thrombocytopenic purpura that were treated in our hospital from January 2022 to January 2023 were selected for this study.They were divided into two groups according the treatment method they were about to receive.The patients in the control group received plasma exchange.The observation group was given rituximab in addition to plasma exchange.Then,the therapeutic effects of the two groups were observed,and the incidence of adverse reactions was compared.Results:The rate of effectiveness of the treatment received in observation group and the control group was 97.14%and 82.86%,respectively.The treatment received in observation group had a better therapeutic effect(P<0.05).The incidence of adverse reactions in the observation group(22.86%)was lower than that of the control group(5.71%),with P<0.05.Conclusion:Rituximab combined with plasma exchange is relatively more effective than plasma exchange alone,with less adverse reaction,making it a viable treatment option.

Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-onchronic liver failure:a nationwide prospective multicenter study in China

BACKGROUND： Plasma exchange （PE）-centered artificial liver support system reduced the high mortality rate of hepa titis B virus （HBV）-related acute-on-chronic liver failure （ACLF）. But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.

Therapeutic plasma exchange and a double plasma molecular absorption system in the treatment of thyroid storm with severe liver injury: A case report

BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means.Plasma exchange(PE)and double plasma molecular absorption system(DPMAS)can be used as an effective treatment for thyroid storm with severe liver injury.CASE SUMMARY A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa.Further,her free T3(FT3)and FT4 levels were significantly elevated,whereas her thyrotropin level was reduced.After admission,her condition continued to deteriorate,and she presented with continued high fever,vomiting,palpitation,and shortness of breath.After being diagnosed with thyroid storm,the patient was immediately treated with PE combined with DPMAS.Her symptoms improved immediately.After three PE+DPMAS treatments,and she was discharged from the hospital.She was treated with methylprednisolone and methylthimidazole.After six months,the patient spontaneously discontinued methylthimidazole treatment.Her previous clinical manifestations and liver dysfunction reoccurred.The patient was treated with PE+DPMAS two times,and her condition rapidly improved.Liver histopathology indicated immunological liver injury.CONCLUSION Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.

Therapeutic plasma exchange for hyperlipidemic pancreatitis:Current evidence and unmet needs

With changes in lifestyle and diet worldwide,the prevalence of hyperlipidemic acute pancreatitis(HLAP)has greatly increased,and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol.There are many available therapies for HLAP,including oral lipid-lowering agents,intravenous insulin,heparin,and therapeutic plasmapheresis(TPE).It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides(TG),thus a rapid decrease in serum TG level is the key to the successful management of HLAP.TPE has emerged as an effective modality in rapidly reducing serum TG levels.However,due to its cost and accessibility,TPE remains poorly evaluated until now.Some studies revealed its efficacy in helping to treat and prevent the recurrence,while some studies suggested that TG levels were not correlated with disease severity,mortality,or length of hospital stay.Thus TPE might have no beneficial effect for the outcome.This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors,adverse effects of the procedure,and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis.Future direction of TPE research for HLAP is also discussed in this review.

The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation

Background:The shortage of donor liver restricts liver transplantation(LT).Nowadays,donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver.Although it is now possible to perform ABO-incompatible(ABO-I)LT,antibody-mediated rejection(AMR)has been recognized as the primary cause of desperate outcomes after ABO-I LT.Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury.Therapeutic plasma ex-change(TPE)can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sources:We searched PubMed and CNKI databases using search terms“therapeutic plasma ex-change”,“ABO-incompatible liver transplantation”,“ABO-I LT”,“liver transplantation”,“LT”,“antibody-mediated rejection”,and“AMR”.Additional publications were identified by a manual search of references from key articles.The relevant publications published before September 30,2020 were included in this review.Results:Different centers have made different attempts on whether to use TPE,when to use TPE and how often to use TPE.However,the control standard of lectin revision level is always controversial,the target titer varies significantly from center to center,and the standard target titer has not yet been estab-lished.TPE has several schemes to reduce antibody titers,but there is a lack of clinical trials that provide standardized procedures.Conclusions:TPE is essential for ABO-I LT.Hence,further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.

Therapeutic plasma exchange in liver failure

The multi-organ failure syndrome associated with acute and acute-on-chronic liver failure(ACLF)is thought to be mediated by overwhelming systemic inflammation triggered by both microbial and non-microbial factors.Therapeutic plasma exchange(TPE)has been proven to be an efficacious therapy in autoimmune conditions and altered immunity,with more recent data supporting its use in the management of liver failure.Few therapies have been shown to improve survival in critically ill patients with liver failure who are not expected to survive until liver transplantation(LT),who are ineligible for LT or who have no access to LT.TPE has been shown to reduce the levels of inflammatory cytokines,modulate adaptive immunity with the potential to lessen the susceptibility to infections,and reduce the levels of albumin-bound and water-bound toxins in liver failure.In patients with acute liver failure,high volume TPE has been shown to reduce the vasopressor requirement and improve survival,particularly in patients not eligible for LT.Standard volume TPE has also been shown to reduce mortality in certain sub-populations of patients with ACLF.TPE may be most favorably employed as a bridge to LT in patients with ACLF.In this review,we discuss the efficacy and technical considerations of TPE in both acute and acute-on-chronic liver failure.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

Retrospective Analysis of Plasma Exchange Combined with Glucocorticosteroids for the Treatment of Systemic Lupus Erythematosus-related Acute Pancreatitis in Central China

Systemic lupus erythematosus-related acute pancreatitis（SLEAP） has a poor prognosis with a high mortality. We described the clinical features of SLEAP, and discussed the feasibility of plasma exchange（PE） combined with glucocorticosteroids（GC） in short-term prognosis and possible mechanism in reducing serum inflammatory cytokine IL-6 and removing serum lipids. A retrospective study was performed by an independent rheumatologist. Medical records of SLEAP from March 2010 to December 2014 were retrieved from Tongji Hospital information system, and patients were divided into two groups according to whether PE therapy was adopted. Sixteen patients treated with PE in combination with GC were classified as group A, and the other 10 patients who were treated with merely GC were classified as group B. Patients＇ clinical remission rate and average daily GC dosage after two-week therapy were compared between the two groups. Patients＇ serum inflammatory cytokines and lipid concentration were compared between baseline and after two-week treatment in both groups. Pearson correlation test was performed to determine association between serum cytokines and Ranson score. SLEDAI score in group A patients at baseline（14.8±3.1） showed no statistical difference from that in group B（14.1±3.3）. At baseline serum IL-6 levels had no significant difference between group A [13.14（11.12, 16.57） mg/L] and group B [14.63（11.37, 16.37） mg/L]; after two-week therapy IL-6 decreased significantly in group A [9.16（7.93, 10.75）mg/L] while it did not show decreasing trend in group B [13.62（9.29,17.63） mg/L]. Serum lipid concentration after two-week therapy in group A [（TC=5.02±0.53, TG=1.46±0.44） mmol/L] decreased significantly compared to baseline [（TC=6.11±0.50, TG=2.14±1.03） mmol/L], while similar tendency was not observed in group B. The remission rate after two-week therapy was higher in group A（70.0%） than in group B（25.0%）. Acute pancreatitis（AP） was one of the clinical manifestations of active SLE. PE combined with GC could reduce serum IL-6 level, and remove serum lipid to improve short-term prognosis. Therefore, it might be a safe and effective way in treating SLEAP and was worth continuing to explore its feasibility.

Successful treatment of plasma exchange-refractory thrombotic thrombocytopenic purpura with rituximab:A case report

BACKGROUND Thrombotic thrombocytopenic purpura(TTP),a subtype of thrombotic microangiopathy,has a very high fatality rate if there is no timely diagnosis or treatment.Here,we report a case of TTP refractory to high displacement plasma exchange,which was later successfully treated with rituximab.CASE SUMMARY Here we report a case of refractory TTP in a 63-year-old woman with a low platelet count and decreased ADAMTS13 activity.Her platelet count was 9×109/L,hemoglobin level was 81 g/L,and ADAMTS13 was<5%.She was diagnosed with thrombotic thrombocytopenic purpura.After 8 d of daily plasma exchange(PEX),her platelet levels were still low.However,after 6 d of treatment with rituximab,her platelet count increased and ADAMTS13 activity returned to normal.CONCLUSION PEX can cure most patients,but the relapse rate can be up to 50%-60%.This case suggested that rituximab can improve the curative efficiency of PEX and prevent disease relapse in TTP.

The Clinical Effects Study of Hepatic Failure by Intraperitoneal Injection of Antibiotics,Intravenous Injection of Terlipressin,and Combined Therapy of Coloclysis and Plasma Exchange

Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.

Plasma exchange in patients with acute and acute-on-chronic liver failure: A systematic review

BACKGROUND Acute liver failure(ALF)and acute-on-chronic liver(ACLF)carry high short-term mortality rate,and may result from a wide variety of causes.Plasma exchange has been shown in a randomized control trial to improve survival in ALF especially in patients who did not receive a liver transplant.Other cohort studies demonstrated potential improvement in survival in patients with ACLF.AIM To assess utility of plasma exchange in liver failure and its effect on mortality in patients who do not undergo liver transplantation.METHODS Databases MEDLINE via PubMed,and EMBASE were searched and relevant publications up to 30 March,2019 were assessed.Studies were included if they involved human participants diagnosed with liver failure who underwent plasma exchange,with or without another alternative non-bioartificial liver assist device.RESULTS Three hundred twenty four records were reviewed,of which 62 studies were found to be duplicates.Of the 262 records screened,211 studies were excluded.Fifty-one articles were assessed for eligibility,for which 7 were excluded.Twenty-nine studies were included for ALF only,and 9 studies for ACLF only.Six studies included both ALF and ACLF patients.A total of 44 publications were included.Of the included publications,2 were randomized controlled trials,14 cohort studies,12 case series,16 case reports.All of three ALF studies which looked at survival rate or survival days reported improvement in outcome with plasma exchange.In two out of four studies where plasma exchange-based liver support systems were compared to standard medical treatment(SMT)for ACLF,a biochemical improvement was seen.Survival in the non-transplanted patients was improved in all four studies in patients with ACLF comparing plasma exchange vs SMT.Using the aforementioned studies,plasma exchange based therapy in ACLF compared to SMT improved survival in non-transplanted patients at 30 and 90-d with a pooled OR of 0.60(95%CI 0.46-0.77,P<0.01).CONCLUSION The level of evidence for use of high volume plasma exchange in selected ALF cases is high.Plasma exchange in ACLF improves survival at 30-and 90-d in nontransplanted patients.Further well-designed randomized control trials will need to be carried out to ascertain the optimal duration and amount of plasma exchange required and assess if the use of high volume plasma exchange can be extrapolated to patients with ACLF.

Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy

BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.

The MELD scoring system for predicting prognosis in patients with severe hepatitis after plasma exchange treatment

BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.

Successful use of plasma exchange in fulminant lupus myocarditis coexisting with pneumonia: A case report

BACKGROUND Fulminant lupus myocarditis is a rare but fatal manifestation of systemic lupus erythematosus.Aggressive immunosuppressive treatments are important in its successful management.However,they can significantly damage the immunity and are associated with a considerable risk of infection development and spread.We present a rare and complicated case of a 20-year-old female diagnosed with fulminant lupus myocarditis accompanied by pneumonia.The patient was successfully treated with plasma exchange(PE)for fulminant lupus myocarditis.CASE SUMMARY A 20-year-old Chinese woman presented to the Hematology Department complaining of fatigue and knee pain.Blood test showed anemia and thrombocytopenia.On the second day of hospitalization,she was transferred to the ICU due to dyspnea and hypotension.Autoimmune profiles showed hypocomplementemia and positive antinuclear antibodies.Computer tomography showed an enlarged heart and pneumonia.Ultrasound revealed an enlarged heart with a low left ventricular ejection fraction.Fulminant lupus myocarditis with cardiogenic shock was initially considered.Due to the accompanying pneumonia,aggressive immunosuppression was contraindicated.Her cardiac function remained critical after the initial therapy of intravenous immunoglobulin and corticosteroids at a conventional dose,but she responded well to later PE therapy plus corticosteroids administration.The patient fully recovered with normal cardiac function.CONCLUSION This case indicates that PE is a valuable treatment choice without adverse effects of immunosuppression in patients with fulminant lupus myocarditis and coexisting infection.

Early plasma exchange and continuous renal replacement therapy improve puerperal prognosis in hepatitis B virus-related acute-on-chronic liver failure in pregnancy

Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF.Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE.Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006).Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.

Modification to poloidal charge exchange recombination spectroscopy measurement in JT-60U tokamak

With consideration of the effects of the atomic process and the sight line direction on the charge exchange re-combination spectroscopy （CXRS）, a code used to modify the poloidal CXRS measurement on Tokamak-60 Upgrade （JT-60U） in Japan Atomic Energy Research Institute is developed, offering an effective tool to modify the measurement and analyse experimental results further. The results show that the poloidal velocity of ion is overestimated but the ion temperature is underestimated by the poloidal CXRS measurement, and they also indicate that the effect of observation angle on rotation velocity is a dominant one in a core region （r/a 〈 0.65）, whereas in an edge region where the sight line is nearly normal to the neutral beam, the observation angle effect is very small. The difference between the modified velocity and the neoclassical velocity is not larger than the error in measurement. The difference inside the internal transport barrier （ITB） region is 2-3 times larger than that outside the ITB region, and it increases when the effect of excited components in neutral beam is taken into account. The radial electric field profile is affected greatly by the poloidal rotation term, which possibly indicates the correlation between the poloidal rotation and the transport barrier formation.

磺化热压PE无纺布的性能研究

利用磺化反应及热压处理,化学改性聚乙烯(PE)无纺布的亲水性和离子交换能力,讨论了时间、温度、热压压力等不同反应条件对材料力学性能的影响,使用显微镜(SEM)对磺化前后PE无纺布的外表状态进行观察,磺化后无纺布表面磺化效果有效提高.实验结果表明,PE无纺布的亲水性和离子交换水平在反应温度为85℃,热压压力为8 MPa,反应时间为2 h的磺化反应条件下,不仅PE无纺布的亲水性和离子交换能力得到了显著的改善,而且拉伸性能和耐腐蚀性能得到了较好保留.

Streptococcal pneumonia-associated hemolytic uremic syndrome treated by T-antibody-negative plasma exchange in children: Two case reports

BACKGROUND The occurrence of Streptococcus pneumoniae-associated hemolytic uremic syndrome(SP-HUS)is increasing.Thomsen-Friedenreich antigen activation is highly involved in the pathogenesis of SP-HUS,and T-antibody-negative plasma exchange(PE)may be effective in the treatment of severe cases of SP-HUS.CASE SUMMARY We retrospectively reviewed two pediatric patients with SP-HUS.Both clinical features and laboratory examination results of the children were described.Tantibody-negative PE was performed in both cases.Both children made a full recovery after repeated PE and remained well at a 2 year follow-up.CONCLUSION Streptococcal pneumonia continues to be an uncommon but important cause of HUS.The successful treatment of the presented cases suggests that T-antibodynegative PE may benefit patients with SP-HUS.

DPMAS与PE治疗肝衰竭的疗效及相关预后预测因子的筛选和预后列线图预测模型的构建

目的观察双重血浆分子吸附系统(DPMAS)与血浆置换(PE)治疗肝衰竭的效果,并筛选其相关预后预测因子,构建预后列线图预测模型。方法前瞻性选取2021年1月至2023年10月新乡市中心医院(新乡医学院第四临床学院)收治的159例行人工肝治疗的肝衰竭患者作为研究对象,其中66例接受PE治疗,43例接受DPMAS治疗,50例接受DPMAS联合PE治疗。统计预后情况,根据预后情况分为预后良好组110例和预后不良组49例,比较两组患者的临床资料,采用Lasso-Logistic回归筛选肝衰竭患者预后情况的独立预测因子,采用受试者工作特征曲线(ROC)评估独立预测因子预测预后的价值,并构建列线预测模型,采用校正曲线、ROC和决策曲线(DCA)曲线评估该模型的预测效能。结果经单因素分析结果显示,终末期肝病评估模式(MELD)评分、谷丙转氨酶(ALT)、治疗方案、白细胞计数(WBC)、感染、国际标准化比值(INR)、上消化道出血、总胆红素(TBIL)、肝性脑病、谷草转氨酶(AST)、肝肾综合征、C反应蛋白(CRP)、白细胞介素-6(IL-6)与DPMAS和PE治疗肝衰竭的预后有关(P<0.05);经Lasso回归分析筛选DPMAS和PE治疗肝衰竭预后的特征变量分别为MELD评分、治疗方案、感染、肝性脑病、ALT、AST、TBIL、INR、CRP、IL-6;经Logistic回归分析结果显示,MELD评分、感染、肝性脑病、ALT、AST、TBIL、INR、CRP、IL-6均是影响DPMAS和PE治疗肝衰竭预后的独立危险因素(P<0.05),DPMAS联合PE治疗是预后的独立保护因素(P<0.05);Lasso-Logistic回归筛选的10个独立预测因子具有良好预测价值,基于10个独立预测因子构建列线图模型,校正曲线结果显示C-index为0.912,校准度为0.895,ROC显示该预测模型的曲线下面积(AUC)为0.853(95%CI:0.778~0.927),DCA曲线显示该模型具有较高的临床正向净获益。结论肝衰竭患者接受DPMAS和与PE治疗后有明显好转,但有部分患者可出现预后不良,其中MELD评分、感染、肝性脑病、ALT、AST、TBIL、INR、CRP、IL-6及DPMAS联合PE治疗是影响肝衰竭患者预后的因素,基于以上因素构建的肝衰竭患者预后列线图预测模型具有良好的预测效能和临床适用性。