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目的:评估一种改良的血浆置换术在治疗成人重型免疫性血小板减少性紫癜(ITP)中的效果及其安全性。方法:对确诊的116例重型ITP患者随机分组进入A、B、C组,A组为改良的血浆置换术联合糖皮质激素43例患者,B组为传统的血浆置换术联合糖皮质激素37例患者,C组为单用糖皮质激素组治疗36例患者。ELISA法检测各组患者治疗前后血小板相关抗体,进行统计学分析;检测血小板计数、凝血功能、血浆蛋白水平变化,进行统计学分析,记录各组治疗期间发生不良反应情况,进行比较分析。结果:A组和B组患者在治疗前后血小板提升及血小板抗体水平下降,与C组比较,差异有统计学意义(P<0.05);A组与B组间比较,A组在提升血小板速度及幅度方面更佳,差异无统计学意义;A组在清除血小板相关抗体能力更强,二者间差异有统计学意义。A、B、C组患者治疗前后在凝血时间、血浆白蛋白、纤维蛋白原水平变化方面,差异无统计学意义;A组血浆球蛋白在治疗后较治疗前有明显下降,差异有统计学意义。A组患者置换后24h内浮肿、头晕、乏力症状发生率较B组有所升高,但A组过敏反应、发热反应等发生率较B组明显下降。结论:改良的血浆置换术联合糖皮质激素在治疗成人重型ITP中疗效明确,疗效优于单纯糖皮质激素及传统的血浆置换术;发生严重不良反应如过敏、发热较传统血浆置换降低,不受血浆供给限制,随时可以开展,可节约大量血浆。但有可能发生低血浆蛋白血症,尤其是低球蛋白血症,需要积极预防。
PURPOSE: To evaluate the efficacy and safety of a modified plasmapheresis in the treatment of adult severe immune thrombocytopenic purpura (ITP). Methods: One hundred and sixty-six patients with severe ITP were randomly divided into A, B and C groups. Group A was treated with modified plasmapheresis and glucocorticoid in 43 patients. Group B received traditional plasmapheresis plus glucocorticoid in 37 patients Patients, group C were treated with glucocorticoid alone group of 36 patients. ELISA method was used to detect the platelet-related antibodies before and after treatment in each group, and statistical analysis was performed. The changes of platelet count, coagulation function and plasma protein level were detected and statistically analyzed. Adverse reactions were recorded and compared during treatment. Results: Compared with group C, the platelet count and platelet antibody level of patients in group A and group B before and after treatment were significantly lower than those in group C (P <0.05). In group A and group B, the increase of platelet velocity and Amplitude better, the difference was not statistically significant; A group in the removal of platelet-associated antibodies more capable, the difference between the two statistically significant. There was no significant difference in the coagulation time, plasma albumin and fibrinogen level between before and after treatment in group A, B and C; the plasma globulin in group A was significantly decreased after treatment than before treatment, the difference was statistically significant . The incidence of edema, dizziness and fatigue in group A was higher than that in group B within 24h after replacement, but the incidence of allergic reaction and fever reaction in group A was significantly lower than that in group B. Conclusion: The modified plasmapheresis and glucocorticoid have a definite curative effect in the treatment of severe ITP in adults, and the curative effect is better than that of simple glucocorticoid and traditional plasmapheresis. Serious adverse reactions such as allergy and fever are lower than those of traditional plasmapheresis Plasma supply restrictions, ready to carry out, can save a lot of plasma. However, hypoproteinemia may occur, especially hypoglycaemia, which requires active prevention.