获得性血栓性血小板减少性紫癜的血浆置换治疗  

Treatment of acquired thrombotic thrombocytopenic purpura by plasma exchange

作　　者：王学文[1] 翟勇平[1] 杨继红[1] 于亚平[1] 刘海宁[1] 史平[1] 唐玉梅[1] 季大玺 曹红琴[1] 

机构地区：[1]南京军区南京总医院血液病科,210002 [2]解放军肾脏病研究所

出　　处：《江苏医药》2008年第4期331-333,共3页Jiangsu Medical Journal

摘　　要：目的探讨血浆置换（PE）治疗获得性血栓性血小板减少性紫癜（TTP）的疗效及影响因素。方法回顾性分析12例TTP患者的临床特征及实验室资料、PE的实施、疗效及影响因素。结果12例TTP中特发性8例，继发性4例，均有微血管性溶血性贫血（MHA）表现、血小板显著减少、明显的神经征象、肾脏损害和发热。给予PE、血浆输注（PI）及联合免疫抑制剂治疗。11例PI2000（400～5400）ml，PE2～10次（中位数2次）；12例PE血浆4900（2900～25000）ml；11例PI＋PE血浆总量3300～27000ml。2例〉20000ml者5（3～22）d起效。生存率83．3oA，特发性、继发性各1例死亡（1例与PE相关）。结论重症TTP者应及早行PE或PI＋PE及联合免疫抑制治疗，以提高缓解率和治愈率，降低复发率。Objective To explore therapeutic efficacy and influence factors of the plasma exchange （PE） in acquired thrombotic thrombocytopenic purpura （TTP）. Methods Clinical manifestations, laboratory data, therapeutic efficacy and influence factors of PE in 12 cases with TTP were retrospectively analyzed. Results Microangiopathic hemolytic anemia （MHA）, marked thrombocytopenia, verying severity of neurologic and renal abnormalities, and fever were all presented in 8 cases with idiopathic TTP and 4 cases with secondary TTP. PE and plasma infusion （PI） were the mainstay of the treatment. Total volume of PI was 400 to 5400 ml （median, 2000 ml） in 11 TTP cases, and that of PE was 2 900 to 25 000 ml （median, 4900 ml） in 12 TTP cases. PI plus PE was performed in 11 cases with total plasma volume of 3300 to 27 000 ml （〉20 000 ml in 2 cases）. Therapeutic effect started in 3-22 d （median, 5 d）. Survival rate was 83.3%. Conclusion The treatment with PE or PE plus PI combined with immunosuppressive drugs should be done as soon as possible in severe TTP cases for improving the remission and decreasing the relapse.

关 键 词：血浆置换 血栓性血小板减少性紫癜 

分 类 号：R554[医药卫生—血液循环系统疾病]