Wollinsky K H, Hülser P J, Brinkmeier H, Aulkemeyer P, Bössenecker W, Huber-Hartmann K H, Rohrbach P, Schreiber H, Weber F, Kron M, Büchele G, Mehrkens H H, Ludolph A C, Rüdel R
Department of Anesthesiology/Intensive Care, Rehabilitation Hospital Ulm, Germany.
Neurology. 2001 Sep 11;57(5):774-80. doi: 10.1212/wnl.57.5.774.
To compare CSF filtration (CSFF) and plasma exchange (PE) in the treatment of patients with Guillain-Barré syndrome (GBS).
In a prospective controlled clinical trial, 37 patients with acute GBS were randomized to receive either CSFF or PE. Inclusion criteria were fulfillment of National Institute of Neurological and Communicative Disorders and Stroke criteria and disability to walk >5 m unassisted.
With similar baseline features in both groups (initial disability grades on the six-point grading scale of the GBS Study Group) the primary outcome variable (improvement within 28 days after randomization) was almost identical (test for equivalence p = 0.0014), the mean grade values being 0.82 in the CSFF group and 0.80 in the PE group. After 56 days, 56% (9 of 16 patients) of the CSFF group and 37% (7 of 19 patients) of the PE group had reached grade 2 (i.e., ability of unassisted walking >5 m). After 6 months, the probability to reach grade 2 was about 80% in both groups. In the CSFF group, transient pleocytosis occurred without apparent clinical complications. Clinically relevant complications were higher in the PE-treated group.
Although the number of patients was small, the authors found that the treatment of GBS with CSFF is at least as effective as with PE. CSFF might work by removing from the CSF inflammatory mediators, autoantibodies, or other factors.
比较脑脊液滤过（CSFF）和血浆置换（PE）治疗吉兰-巴雷综合征（GBS）患者的效果。
在一项前瞻性对照临床试验中，37例急性GBS患者被随机分为接受CSFF或PE治疗两组。纳入标准为符合美国国立神经疾病与卒中研究所标准且无法独立行走超过5米。
两组基线特征相似（GBS研究组六点分级量表初始残疾等级），主要结局变量（随机分组后28天内的改善情况）几乎相同（等效性检验p = 0.0014），CSFF组平均等级值为0.82，PE组为0.80。56天后，CSFF组56%（16例中的9例）和PE组37%（19例中的7例）达到2级（即能够独立行走超过5米）。6个月后，两组达到2级的概率约为80%。CSFF组出现短暂性细胞增多症，但无明显临床并发症。PE治疗组临床相关并发症较多。
尽管患者数量较少，但作者发现CSFF治疗GBS至少与PE一样有效。CSFF可能通过清除脑脊液中的炎症介质、自身抗体或其他因素发挥作用。
