血浆置换治疗240例难治性风湿病的临床疗效评价  

Clinical effectiveness of plasma exchange in 240 cases suffering from refractory rheumatism

作　　者：王金凯[1] 吴薇薇[1] 杨清云[1] 

机构地区：[1]河北医科大学第三医院,河北石家庄050051

出　　处：《透析与人工器官》2001年第1期3-8,共6页Chinese Journal of Dialysis and Artificial Organs

摘　　要：目的 :观察、评价应用血浆置换疗法结合免疫抑制剂治疗难治性风湿病的临床疗效。方法 :治疗组2 4 0例难治性风湿病患者 ,应用血浆置换疗法结合免疫抑制剂治疗。血浆置换每周 1～ 2次 ,每次去除血浆 830～ 150 0 ml,4次一疗程 ,总量达 3～ 6 L。在活动性强直性脊柱炎 (AAS)和难治性类风湿关节炎 (RRA)患者 ,在血浆置换同时应用环磷酰胺 (CTX) 2 0 0 mg静点 ,隔日 1次 ,利美达松 4 mg静注 ,每周 1次 ,连用 4周为 1个疗程。在狼疮性肾炎 (L N)患者 ,用 CTX 50 0 mg/ m2 ,每周静点 1次 ,4周后改为每 3月 1次 ;同时设立对照组 ,4 5例 AAS和 30例 RRA仅用 NSAID和 SAARDs,在 L N对照组 14例单用 iv- CTX。结果 :治疗组在AAS、RRA和 LN总有效率分别为 97.4 1%、96 .6 7%和 94 .74 % ;对照组分别为 82 .2 2 %、78.13%、6 4 .3%。在混合性结缔组织病 ,皮肌炎 ,进行性系统性硬化症 ,牛皮癣脊柱炎关节病和重叠综合征的治疗组总有效率分别为 8 0 %、6 6 .6 6 %、6 6 .6 6 %、10 0 %和 10 0 %。结论 :应用血浆置换结合免疫抑制剂治疗难治性风湿病疗效高、见效快、缓解期长 ,且副作用无明显增加。是抢救风湿病危象的一种有效措施。Objective:To assess clinical effectiveness in refractory rheumatism used plasma exchange (PE) combineds with immunodepresive.Methods:PE was done one or two time every week and four time as a course of therapy,and at the same time we used cyclophosphamide 200mg three time a week by venous trnsfusion,limethason 4mg once time a week by venoclysis in the active ankylosing spondylitis (AAS) and refractory rheumatoid arthritis(RRA).PE was done one time every week combined with cyclophosphamide 500mg one a week by venoclysis for 4 week in the lupus nephritis (LN).Results:The remarkable effective in the treatment group of AAS,RRA and LN,the total effective rate were respectively 97.41%,96.67% and 94.74% after the therapy;the total effective rate were respectively 82.22%,78.13% and 64.3% in the control group.Conclusion:The therapy of PE combination with immunodepressive to refractory rheumatism has the faster,better results,littel side effects and longer remission stage than the control group,and was a more effective measure for critical of rheumatism.

关 键 词：血浆置换 治疗 难治性风湿病 疗效评价 

分 类 号：R593.21[医药卫生—内科学] R459.5[医药卫生—临床医学]