血浆置换疗法治疗糖皮质激素不敏感或者不耐受重症药疹临床疗效观察  

Clinical observation on therapeutic efficacy of plasma exchange in 35 patients with severe drug eruption refractory to steroids

作　　者：黄悦[1] 周凌辉[2] 林维嘉[1] 余剑华[3] 蔡良奇[1] 

机构地区：[1]厦门大学附属第一医院暨福建医科大学厦门市第一医院教学医院皮肤性病科,福建厦门361002 [2]厦门大学附属第一医院暨福建医科大学厦门市第一医院教学医院肾内科,福建厦门361002 [3]厦门大学附属第一医院暨福建医科大学厦门市第一医院教学医院重症医学科,福建厦门361002

出　　处：《临床和实验医学杂志》2017年第16期1662-1665,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨血浆置换疗法治疗糖皮质激素不敏感或者不耐受重症药疹的临床疗效。方法对不能耐受糖皮质激素和(或)经过大剂量糖皮质激素联合静脉用丙种球蛋白仍难以控制的35例重症药疹患者,采用Aquarius血细胞模式分离机,将患者血液分离为血浆和细胞成分,弃血浆,将置换液与分离的细胞成分一起回输患者体内,进行连续性血浆置换,每例置换1~6次不等,观察其临床疗效及转归情况。结果 35例患者中30例(85.71%)获得满意疗效,置换后激素最大使用量明显低于置换前(P<0.05);5例(14.29%)遗留后遗症,包括角膜损伤、轻度肝肾功能不全等;7例(20%)出现不良反应,包括发热、寒战、四肢麻木、风团、抽搐。结论血浆置换疗法辅助治疗激素不敏感或者激素不耐受重症药疹可获得较好疗效。Objective To explore the clinical effect of plasma exchange（ PE） in patients with severe drug eruption refractory to steroids.Methods Plasma exchange was carried out for treatment in 35 patients with severe drug eruption refractory to steroids and IVIG. In order to observe its clinical efficacy and outcome,aquarius blood cell separator was utilized to collect cell components from blood of patients,and the replacement of fluid and cell components had been infused back into patients. Patients received 1 to 6 sessions of plasma exchange,respectively. Results85. 71%（ 30/35） of patients appeared satisfactory effect. The maximum dosage of corticosteroid after plasmapheresis was much lower than that used before PE treatment（ P 〈 0. 05）. Sequelae occurred in 5（ 14. 29%） patients,including corneal injury and mild liver and renal dysfunction; and other side effects such as fever,shivering,numbness of limbs,urticaria and convulsion appeared in 7（ 14. 29%） cases. Conclusion Plasma exchange as a supportive therapy is beneficial for patients with severe drug eruption refractory to steroids.

关 键 词：重症药疹 激素不敏感 激素不耐受 血浆置换 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]