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选择性单双膜血浆置换在免疫性疾病及肾移植急性排斥反应中的应用
刘华,高菊林,蒋红利,王瑜
0
(西安交通大学第一附属医院血液净化科)
摘要:
【摘要】 目的 探讨单膜/双膜血浆置换在治疗自身免疫性疾病及同种异体肾移植术后发生急性排斥反应患者中的临床效果。方法 纳入2015年10月~2017年6月期间选择性应用单膜/双膜血浆置换治疗患者19例,每例进行1~8次治疗,测定治疗前后血浆免疫球蛋白IgG、IgM、IgA表达水平,测定并记录不同疾病的特异性抗体表达水平以及不良反应发生情况,观察并记录伴发肾功能不全或移植排斥反应的患者治疗前后肾功能、尿量恢复情况等.结果 单膜血浆置换12例次,双膜血浆置换58例次,治疗前后IgG差异有统计学意义(P<005),而IgM、IgA未见显著差异(P>005)。不同疾病预后:SLE合并继发性血栓性血小板减少性紫癜1例,血小板最低12×109/L,抗核抗体(+),经5次单膜血浆置换配合内科治疗,意识好转,血小板恢复正常,抗核抗体();急进性肾炎患者11例,配合药物治疗后抗KSZ抗体平均水平有下降趋势,但差异无统计学意义(P>005),抗GBM呈显著性下降(P<005);肾移植术后急性排斥反应7例患者行双膜血浆置换,总体PRA有下降趋势但差异无统计学意义(P>005),结论 单膜/双膜血浆置换技术能迅速降低自身免疫性疾病患者血液中免疫球蛋白IgG、抗GBM抗体的表达水平,临床治疗应根据具体情况选择具体方法。
关键词:  血浆置换  免疫性疾病  排斥反应
DOI:
基金项目:陕西省社会发展科技攻关项目;西安交通大学第一附属医院院基金项目;西安交通大学第一附属医院普通新医疗新技术项目
Selective single membrane/double membrane plasmapheresis in the treatment of immune diseases and acute renal allograft rejection
LIU Hua,GAO Julin,JIANG Hongli,WANG Yu
(Department of Blood Purification, The first affiliated Hospital of Xi'an Jiaotong University)
Abstract:
【Abstract】 Objective Single/double membrane plasma exchange, as the main means of plasma purification treatment, is specifically recommended for Immune related diseases in the American Society for Apheresis (ASFA) guidelines, including the acute rejection after renal transplantation, vasculitis and antiGBM antibody nephritis, etc. This article summarizes the single/double membrane plasma exchange in 19 cases in our hemodialysis center, to explore the clinical curative effect. Methods From October 2015 to June 2017, selective use of single/double membrane plasma exchange was carried out for 19 patients, 18 times each patient treatments. Plasma IgG, IgM and IgA were measured before and after treatment, and the specific antibody for different diseases was determined, renal function of renal transplant and nephritis patients and urine volume recovery were recorded. Results There were 12 cases of single membrane plasma exchange and 58 cases of double membrane plasma exchange. There were significant differences in IgG before and after treatment (P<005), while IgM and IgA showed no significant difference. The outcomes were different in different disease: The patient of SLE with ITP, who was in critical condition at beginning of very low platelet (12×109/L), unconsciousness, dysphoria, antinuclear antibody (+), improved in consciousness, PLT (normal) and the negative antinuclear antibodies after 5 times of single membrane plasma exchange with medical treatment. The RPGN patients, after cooperated with medical treatment, there is a decrease of antiKSZ antibodies in the average trend but not significant (P>005), antiGBM were significantly decreased (P<005), and 4 cases (only positive antiGBM) from got rid of hemodialysis therapy, 3 cases were given up for treatment due to economic and advanced age, but renal function were not recovered in 4 cases and were converted to maintenance hemodialysis. 7 cases of acute rejection after kidney transplantation were carried out double membrane plasma exchange, overall PRA has a downward trend but no statistical significance (P>005), renal function and urine amount is back to normal, 5 patients were followed up for six months and the nor renal function was normal, but Two patients were converted to maintenance hemodialysis. Conclusion Single/double membrane plasma exchange technology has been gradually play an irreplaceable role in the treatment of autoimmune diseases, cooperating with drug treatment. Different disease characteristics, and adequacy of the plasma source makes clinicians need to selective to use single/double membrane plasma exchange or joint method in two ways according to the specific circumstances of patients, on the basis of immunosuppressive drugs used to promote disease prognosis.
Key words:  Plasma exchange  Immune diseases  Rejection

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