血浆置换治疗超晚发型视神经脊髓炎谱系疾病的疗效分析  

Analysis of efficacy and safety of plasma exchange in patients with very late-onset neuromyelitis optica spectrum disorder

作　　者：张晔琼 吕朴 矫毓娟[1] 崔蕾[1] 张伟赫[1] 焦劲松[1] 刘尊敬[1] 彭丹涛[1] ZHANG Ye-qiong;LV Pu;JIAO Yu-juan(Department of Neurology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院,神经科,北京100029

出　　处：《中日友好医院学报》2020年第3期135-139,共5页Journal of China-Japan Friendship Hospital

摘　　要：目的:探讨血浆置换治疗超晚发型视神经脊髓炎谱系疾病(VLONMOSD)的有效性和安全性。方法:回顾分析中日友好医院2013年11月~2019年11月收治的3例确诊为视神经脊髓炎谱系疾病(NMOSD)的超晚发型患者(发病年龄≥75岁)应用血浆置换(PE)的疗效与安全性。结果:3例患者中2例女性,1例男性,首次发病年龄分别为78岁、77岁、76岁,PE年龄分别为82岁、77岁、76岁,PE平均年龄78.3岁。共计4次发作应用PE治疗,其中3次为横贯性脊髓炎(TM)发作,1次为视神经炎(ON),例2的ON发作和例3的1次TM发作首选静脉滴注甲泼尼龙冲击无效后给予PE挽救治疗。3次TM发作经治疗后症状改善,例1的第二次TM复发症状显著改善,第一次TM复发症状轻度改善;例3的TM发作治疗后症状轻度改善,例2的1次ON发作经治疗后视力无明显改善。PE的不良反应依次为:血压下降、肝素相关性血小板计数减少,均为短暂且可逆性,未发生导致治疗终止的严重不良反应。结论:PE可作为VLONMOSD患者的首选或补救治疗措施,安全性基本良好。Objective:To explore the therapeutic efficacy and safety of plasma exchange(PE)in the treatment on patients with very late-onset neuromyelitis optica spectrum disorder(VLONMOSD).Methods:Retrospective analysis was performed on the efficacy and safety of PE in 3 hospitalized patients diagnosed with NMOSD(age≥75 years)in our department from November 2013 to November 2019.Results:Two of the three patients were female and one was male.The age of first onset was 78,77 and 76 years,respectively;the age of PE was 82,77 and 76 years,respectively;the average age of PE was 78.3 years old.Four attacks were treated with PE,3 of which were transverse myelitig(TM)and 1 was optic neuritis(ON).In case 2 of ON attack and case 3 of TM attack,PE was given as rescue therapy after the failure of intravenous methylprednisolone(IVMP).The symptoms of 3 spinal attacks improved after treatment.In case 1,the symptoms of second TM relapse were significantly improved after PE,while the first TM relapse showed mild improvement;in case 3,the symptoms of first TM attack were mildly improved after PE;in case 2,there was no improvement in vision after treatment.The adverse reactions of PE were decrease of blood pressure and heparin-associated thrombocytopenia,both were transient and reversible.None of the 3 patients had serious adverse reactions that led to the termination of treatment.Conclusion:PE can be used as the preferred method or rescue therapy for the treatment of patients with VLONMOSD,which is safe and well-tolerated.

关 键 词：超晚发 视神经脊髓炎谱系疾病 血浆置换 疗效 安全 

分 类 号：R457.14[医药卫生—治疗学] R744.52[医药卫生—临床医学]