离心-膜杂合式血浆置换和离心式治疗性血浆置换在高脂血症中的应用对比  

Comparison of centrifugal-membrane hybrid plasmapheresis and centrifugation therapeutic plasma exchange in hyperlipidemia

作　　者：张彬 吴春曦 周渝萌 周芳 易中梅 ZHANG Bin;WU Chunxi;ZHOU Yumeng;ZHOU Fang;YI Zhongmei(Department of Blood Transfusion,Southwest Hospital,Third Military Medical University(Army Medical University),Chongqing 400030,China;Department of Blood Transfusion,Army 73rd Group Army Hospital,Xiamen 361000,China)

机构地区：[1]陆军军医大学第一附属医院输血科,重庆400030 [2]陆军第七十三集团军医院输血科,福建厦门361000

出　　处：《中国输血杂志》2024年第12期1365-1370,共6页Chinese Journal of Blood Transfusion

摘　　要：目的建立1种全新的离心-膜杂合式血浆置换(centrifugal-membrane hybrid plasmapheresis,CMHP)模式,通过与离心式治疗性血浆置换(centrifugation therapeutic plasma exchange,cTPE)比较,观察其治疗高脂血症的临床效果、安全性及优势。方法回顾性分析2021年8月至2023年9月在本科治疗的47例高脂血症患者,共60次治疗。分为2组:CMHP组37例患者,46次治疗;cTPE组10例患者,14次治疗。CMHP组采用血细胞分离机分离血浆+二级膜血浆成分分离器分离血浆成分的脂蛋白单采技术,cTPE组采用血细胞分离机分离血浆进行治疗性血浆置换。对比2组的临床效果、安全性及优势。结果CMHP组治疗前后总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)下降率分别为68.56%[59.81%,73.42%]、65.80%[55.55%,75.98%]、46.57%[36.02%,54.83%]及66.67%[43.48%,76.24%],差异具有统计学意义(P<0.001)。cTPE组治疗前后TC、TG及HDL-C下降率分别为42.52%[29.67%,49.85%]、52.32%[38.43%,67.07%]及22.36%[8.51%,33.65%],差异具有统计学意义(P<0.05)。CMHP组血浆处理倍数1.48(0.29)[均数(标准差)]明显高于cTPE组0.87(0.26),差异具有统计学意义(P<0.001),导致CMHP组的TC及HDL-C下降率均高于cTPE组,差异具有统计学意义(P<0.001),而2组的TG下降率差异不具统计学意义(P>0.05)。同时cTPE组需输入血浆1520.00 mL[1462.50 mL,2000.00 mL],而CMHP组实现了血液的零输入。CMHP组不良反应率6.52%(3/46),cTPE组为7.14%(1/14),差异不具统计学意义(P>0.05)。结论CMHP较cTPE能够更好地降低血脂水平,且无需任何血液制品,避免了血液传染病的传播,不良反应发生率低,具有较好的临床应用前景。Objective To establish a new centrifugal-membrane hybrid plasmapheresis(CMHP)model,and observe its clinical efficacy,safety and advantages in the treatment of hyperlipidemia by comparing with centrifugation therapeutic plasma exchange(cTPE).Methods A retrospective analysis was performed on 47 patients with hyperlipidemia treated in our department from August 2021 to September 2023,with a total of 60 treatments.They were divided into two groups:CM-HP group with 37 patients and 46 treatments;cTPE group included 10 patients with 14 treatments.In the CMHP group,the plasma was separated by a blood cell separator and the plasma components were separated by a two-stage membrane plasma component separator.In the cTPE group,the plasma was separated by a blood cell separator for therapeutic plasma ex-change.The clinical efficacy,safety and advantages of the two groups were compared.Results The reduction ratios of to-tal cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein choles-terol(LDL-C)before and after treatment in CMHP group were 68.56%[59.81%,73.42%],65.80%[55.55%,75.98%]and 46.57%[36.02%,54.83%]and 66.67%[43.48%,76.24%]respectively,with statistically significant difference(P<0.001).The decrease ratios of TC,TG and HDL-C before and after treatment in cTPE group were 42.52%[29.67%,49.85%],52.32%[38.43%,67.07%]and 22.36%[8.51%,33.65%],respectively,and the difference was statistically significant(P<0.05).The plasma treatment multiple was 1.48(0.29)in CMHP group,which was signifi-cantly higher than 0.87(0.26)in cTPE group,with a statistically significant difference(P<0.001),resulting in higher TC and HDL-C reduction ratios in CMHP group than in cTPE group,with a statistically significant difference(P<0.001),while there was no significant difference in TG reduction rate between the two groups(P>0.05).At the same time,the cTPE group required 1520.00 mL[1462.50 mL,2000.00 mL]plasma input,while the CMHP group achieved zero blood input.The adverse reaction ratio was 6.52%(3/

关 键 词：离心-膜杂合式血浆置换 治疗性血浆置换 离心式 高脂血症 

分 类 号：R457.1[医药卫生—治疗学]