单次双重血浆置换对合并丙肝的维持透析患者血浆成分和丙肝病毒载量的影响  

Effect of double filtration plasmapheresis therapy on plasma components and hepatitis C viral load in maintenance hemodialysis patients

作　　者：武晓春 李宁 吐尔干巴衣·周立达西 帕尔曼·阿布杜许库尔 WU Xiaochun;LI Ning;Tuerganbayi•Zhoulidaxi;Paerman•Abuduxukuer(Department of Nephrology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China;Department of Nephrology,the people's Hospital of Kizilsu Kirghiz Autonomous Prefecture,Kizilsu Kirghiz,Xinjiang 845350,China)

机构地区：[1]南京医科大学第二附属医院肾内科 [2]新疆克孜勒苏柯尔克孜自治州人民医院肾病内科

出　　处：《新疆医学》2019年第10期996-1002,共7页Xinjiang Medical Journal

摘　　要：目的观察双重血浆置换治疗合并丙型病毒性肝炎的维持性血液透析患者的疗效和安全性。方法 25例合并丙肝的血液透析患者,外周血丙肝病毒核糖核酸大于1×105copies/ml,观察单次双重血浆置换治疗前后相关指标变化。结果经单次双重血浆置换治疗,血白蛋白浓度降低5.62%~29.82%,球蛋白降低14.15%~40.89%,纤维蛋白原降低32.12%~72.35%,免疫球蛋白A降低27.62%~47.92%,免疫球蛋白G降低23.31%~39.18%,免疫球蛋白M降低56.10%~81.29%,总胆固醇降低49.55%~76.86%,甘油三酯降低9.45%~84.38%,高密度脂蛋白胆固醇降低14.29%~51.82%,低密度脂蛋白胆固醇降低41.11%~91.84%,丙肝病毒核糖核酸降低9.93%~81.33%,前后比较差异均有统计学意义(P<0.001),血浆蛋白的下降率与分子量之间存在直线正相关关系(P=0.023),治疗中与治疗后患者耐受性良好,临床症状改善。结论双重血浆置换可以降低此类患者血浆蛋白和血脂,同时降低外周血丙肝病毒载量,且安全有效,有一定的临床应用价值。Objective To investigate the therapeutic effect and safety of DFPP to MHD patients with hepatitis C. Methods 25 patients of hemodialysis combined with hepatitis c, peripheral blood hepatitis c virus RNA was larger than 1 ×105 copies/ml, and the changes of related indexes before and after single double plasmapheresis were observed. Results By single double plasma exchange treatment, blood albumin concentrations reduce 5.62% ~ 29.82%, globulin lower 14.15% ~ 40.89%, and fibrinogen reduced by 32.12% ~72.35%, immunoglobulin A reduced by 27.62% ~ 47.92%, immunoglobulin G reduced by 23.31% ~ 39.18%, and immunoglobulin M reduced by 56.10% ~ 81.29%, and total cholesterol by 49.55% ~ 76.86%, triglycerides by 9.45% ~ 84.38%, 14.29% ~ 51.82% lower leels of HDL cholesterol, low density lipoprotein cholesterol by 41.11% ~ 91.84%, hepatitis c virus(HCV)RNA reduced by 9.93% ~81.33%, and compared before and after the difference had statistical significance(P < 0.001), plasma protein decline rate and molecular weight linear positive correlation between(P = 0.023), and well tolerated treatment and after treatment in the patients, the clinical symptoms improved. Conclusion Dual plasmapheresis can reduce plasma protein and blood lipid, and reduce viral load of hepatitis c in peripheral blood.

关 键 词：维持性血液透析 丙型病毒性肝炎 双重血浆置换 

分 类 号：R692.5[医药卫生—泌尿科学]