双重血浆置换与单重血浆置换治疗狼疮性肾炎患者比较分析  

Double filtration plasmapheresis and single plasmapheresis in the treatment of patients with lupus nephritis:a comparative analysis

作　　者：史应龙[1] 吴卓媚[1] 杨兴刚[1] 李仕华[1] 谭春兰 任烨 周红卫[1] SHI Yinglong;WU Zhuomei;YANG Xinggang;LI Shihua;TAN Chunlan;REN Ye;ZHOU Hongwei(Department of Blood Purification,the First Affiliated Hospital of Guangxi Medical University,Naning 530021,China)

机构地区：[1]广西医科大学第一附属医院血液净化部,南宁市530021

出　　处：《内科》2021年第3期308-311,共4页Internal Medicine

基　　金：广西壮族自治区卫生健康委员会计划课题(Z20190756)。

摘　　要：目的比较双重血浆置换(DFPP)与单重血浆置换治疗狼疮性肾炎患者的临床效果。方法选取2017年8月至2019年12月我院收治的狼疮性肾炎患者34例,采用随机数字法分为观察组与对照组,每组17例。观察组患者给予DFPP治疗,对照组患者给予单重血浆置换治疗。比较两组患者治疗前、治疗2周后的疾病活动度评分(SLEDAI评分)、血清补体C3水平、24h蛋白尿定量(24hUP)以及血清免疫球蛋白G(IgG)、抗ds-DNA抗体、血清白蛋白(ALB)、纤维蛋白原(FIB)水平;比较两组患者治疗期间的不良反应发生情况。结果治疗2周后,两组患者的SLEDAI评分、24hUP以及IgG、抗ds-DNA抗体、FIB水平均显著降低,观察组患者的水平显著低于对照组;两组患者的C3、ALB水平显著增高,观察组患者的C3水平显著高于对照组(P<0.05),两组患者的ALB水平比较差异无统计学意义(P>0.05)。治疗期间,两组患者的导管感染发生率比较差异无统计学意义(P>0.05);对照组患者的过敏反应发生率、枸橼酸反应发生率显著高于观察组,差异有统计学意义(P<0.05);两组患者的低血压发生率比较差异无统计学意义(P>0.05)。结论双重血浆置换治疗狼疮性肾炎的疗效优于单重血浆置换,但会引起机体纤维蛋白原降低,临床应用时应加以注意。Objective To compare the clinical effects of double filtration plasmapheresis(DFPP)and single plasmapheresis in the treatment of patients with lupus nephritis.Methods A total of 34 patients with lupus nephritis admitted to our hospital from August 2017 to December 2019 were selected and divided into observation group and control group by the random number method,with 17 cases in each group.The observation group was treated with DFPP,whereas the control group was treated with single plasmapheresis.The scores of Systemic Lupus Erythematosus Disease Activity Index(SLEDAI),serum complement C3,24-hour proteinuria(24hUP),serum immunoglobulin G(IgG),anti ds-DNA antibody,serum albumin(ALB)and fibrinogen(FIB)were compared between the two groups before and 2 weeks after treatment.The adverse reactions of the two groups were compared during the treatment.Results After 2 weeks of treatment,SLEDAI scores,24hUP,IgG,anti ds-DNA antibody and FIB levels of the two groups significantly decreased,and the levels mentioned above in the observation group were significantly lower than those in the control group(P<0.05).The levels of C3 and ALB significantly increased,and compared to the control group,the observation group yielded a higher level of C3(P<0.05),but there was no statistically significant difference in ALB level between the two groups(P>0.05).During the treatment,there was no statistically significant difference in the incidence of catheter infection and hypotension between the two groups(P>0.05).The incidence of allergic reaction and citric acid reaction in the control group was significantly higher than that in the observation group,with a statistically significant difference(P<0.05).Conclusions Double plasmapheresis in the treatment of lupus nephritis is superior to single plasmapheresis;however,it will cause fibrinogen reduction in the body,which should be paid attention to in clinical application.

关 键 词：狼疮性肾炎 双重血浆置换 单重血浆置换 纤维蛋白原 

分 类 号：R459.5[医药卫生—治疗学]