摘要
目的：建立一种离心式与膜式血浆分离技术组合的新型双重血浆置换（DFPP）模式,通过前瞻、非随机对照研究与膜式DFPP比较,观察其临床治疗的有效性、安全性及优势。方法：入选因抗肾小球基膜（GBM）抗体或抗中性粒细胞胞质抗体（ANCA）介导疾病需行DFPP的患者,分为两组：已有中心静脉导管及可充分抗凝者接受膜式DFPP,其余患者接受组合式DFPP。前者采用血浆分离器MPS07分离血浆,后者采用血细胞分离机分离血浆,两组均经二级血浆成分分离器EC20W进行再处理。单次治疗处理1.5倍血浆量,每次补充35~45g人血白蛋白。结果：入选32例患者（男性15例）,膜式DFPP组14例,组合式DFPP组18例。共行DFPP 79次,其中膜式DFPP 27次。膜式及组合式DFPP对Ig G、Ig A、Ig M的下降率无差别;白蛋白补充量及治疗后血清白蛋白的下降率亦无明显差别;血小板下降率两者相似（P=0.114）;但膜式DFPP致病抗体的下降率显著低于组合式DFPP[（25.62%±11.67%）vs（36.78%±16.44%）,P=0.043]。膜式DFPP组治疗中血流量显著高于组合式DFPP组（P〈0.001）;组合式DFPP低分子肝素使用量明显少于膜式DFPP（P〈0.001）;组合式DFPP没有增加分离器凝血、溶血、破膜等不良反应。结论：离心/膜分离组合式DFPP除明显技术优势包括血流量要求低、抗凝需求低外,还具有更好的致病性抗体清除效果,其对血小板的影响与传统DFPP并无差别,不良反应发生率低,具有较好的应用前景。
Objective： To establish a new mode of double filtration plasmapheresis （DFPP） combining centrifugal/membranous plasma separation techniques, and to evaluate its efficacy, safety and advantages compared with the traditional membranous DFPP （M-DFPP） through a prospective, nonrandomized controlled study. Methodology： Patients requiring DFPP treatment were screened for enrollment. They received DFPP due to renal diseases associated with anti-neutrophil cytoplasmic antibody （ANCA） or anti-glomerular basement membrane （GBM） antibody. After enrollment, patients who already had central venous catheter and had no contraindications for adequate systemic anticoagulant were assigned to receive M-DFPP, and the others were assigned to receive centrifuge/membrane hybrid DFPP （ C/M-hybrid DFPP）. For M-DFPP, plasma was separated by a plasma separator MPS07, and passed through a fractional plasma separator EC20W for a second filtration; while for C/M-hybrid DFPP, plasma was separated by a centrifugal apheresis system and was secondly filtrated through a EC20W filter, which was the same as in M-DFPP. For one session of DFPP, up to 1.5 fold of the total plasma volume was processed, with a supplement of 35 - 45g human albumin. Results： 32 patients （ 15 males） were divided into 14 in M-DFPP and 18 in C/M-hybrid DFPP. A total of 79 sessions of DFPP were performed,with 27 sessions of M-DFPP and 52 sessions of C/M-hybrid DFPP. There was no significant difference between M-DFPP and C/M-hybrid DFPP in the regards of reduction ratio of IgG, IgA, IgM, as well as the amount of supplemented human albumin, reduction ratio of serum albumin and platelets counts [ （9. 05%±11.89%） vs （ 17.00%±14. 91%） ,P=0. 114]. While for the reduction ratio of the titer of autoimmune antibodies, C/M-hybrid DFPP was higher than M-DFPP [ （36.78%±16.44%） vs. 25.62%±11.67%） , P=0. 043]. The blood flow rate in M-DFPP was significantly higher than that in C/M-hybrid DFPP [ （118.21±8.68） ml/min vs. （35.29±4. 14）
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2016年第5期437-443,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家自然科学基金(81170708)
关键词
致病抗体
血细胞分离机
双重血浆置换
血细胞
不良反应
autoimmune antibody blood cell separator double filtration plasmapheresis blood cell side effect
