摘要
目的探讨冷上清血浆置换（PE）治疗血栓性血小板减少性紫癜（TTP）的疗效及其对患者凝血功能的影响。方法选择2017年1月22日，四川大学华西医院血液内科收治的1例TTP患者为研究对象。该例患者人院后第3～7天，对其采用冷上清为置换液进行PE治疗（1次／d）后，同时输注新鲜冰冻血浆（FFP）补充纤维蛋白原（Fib）。对该例患者每次冷上清治疗前、后进行血常规及凝血功能等指标检测，分析冷上清治疗TTP的疗效及其对患者凝血功能的影响。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。结果对该例患者采用冷上清为置换液进行PE治疗的结果显示：①第1次采用冷上清治疗及同时输注FFP治疗后，患者精神、神经症状消失。连续进行5次冷上清治疗后，患者血小板计数由5×10^9／L逐渐恢复正常[（100～300）×10^9／L]，血红蛋白（Hb）值由最低时的57g／L逐渐恢复正常（110～150g／L）。②每次采用冷上清治疗后，血浆Fib水平均较治疗前明显降低，而输注FFP后，恢复至治疗前水平；5次治疗后，血浆Fib值为1．31g／L（正常参考值为2．OO～4．00g／L），而活化部分凝血活酶时间（APTT）和凝血酶原时间（PT）等凝血功能指标无明显延长。③出院后随访半年，患者Hb值、血小板计数均维持正常。结论临床对TTP采用冷上清为置换液进行PE治疗有效，但是可导致患者血浆Fib水平降低，若同时输注FFP，则可得到纠正。因为本研究仅为个案报道，采用冷上清为置换液进行PE治疗TTP的疗效，仍有待大样本、多中心、前瞻性随机对照研究结果进一步证实。
Objective To study the efficacy of plasma exchange （PE） with cryosupernatant in treatment of thrombotic thrombocytopenic purpura （TTP）, and its influences on blood coagulation. Methods A case of TTP patient who was treated on January 22, 2017 in Department of Hematology, West China Hospital, Sichuan University was selected as the study subject. On the 3rd to 7th day after admission, the patient was treated by PE with cryosupernatant as displacement liquid once a day, and was infused with fresh frozen plasma （FFP） for the supplement of fibrinogen （Fib） at the same time. Blood routine and coagulation function were detected before and after each time of cryosupernatant treatment, to analyze the efficacy of cryosupernatant in treatment of TTP and its influences on coagulation function. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results The results of the patient treated by PE with cryosupernatant as displacement liquid showed as follows. ①After receiving the first time of cryosupernatant treatment and infusion of FFP, the mental neurological symptoms of the patient disappeared. And the platelet count gradually recovered from 5×10^9/L to normal [-（100-300）×10^9/L], and hemoglobin （Hb） value returned to normal （110-150g/L） from the lowest value of 57 g/L after 5 times of consecutive treatment by cryosupernatant. O After receiving each time of cryosupernatant treatment, the plasma Fib level of the patient was significantly lower than that before cryosupernatant treatment, however the plasma Fib level recovered to the level before cryosupernatant treatment. After 5 times of cryosupernatant treatment, the patient＇s plasma Fib value was lowest to 1. 31 g/L （normal reference value was 2.00 4.00 g/L）, while there was no significant prolongation of the activated partial thromboplastin （APTT） and prothrombin time （PT）. @The Hb level and platelet count of the patient were maintained at normal level during the half year f
作者
冷亚美
王颖莉
李亚容
严天友
李燕
龚玉萍
沈恺
牛挺
朱焕玲
刘霆
Leng Yamei;Wang Yingli;Li Yarong;Yan Tianyou;Li Yan;Gong Yuping;Shen Kai;Niu Ting;Zhu Huanling;Liu Ting(Department of Hematology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《国际输血及血液学杂志》
CAS
2018年第3期221-225,共5页
International Journal of Blood Transfusion and Hematology
