Gokhale Y A, Bhide S, Rajadhyaksha S, Bichile L S, Hase N K
Department of Medicine, LTM Medical College Sion, Mumbai.
J Assoc Physicians India. 2001 Oct;49:986-9.
We report our experience with use of plasmapheresis (PP) as an adjunct therapy in severe progressive neuropsychiatric systemic lupus erythematosus (NPSLE).
Three patients of NPSLE (including 2 with status epilepticus) who were progressively worsening on steroids or combination of pulse cyclophosphamide (CPM) and steroids were treated with PP followed by synchronized CPM. Pre and post treatment SLE Disease Activity Index (SLEDAI) and laboratory tests were carried out.
Significant clinical improvement with decrease in SLEDAI occurred immediately following PP. Mean SLEDAI before and after PP were 33 and 11. Mean erythrocyte sedimentation rate decreased from 121 to 31. Rebound flare of disease activity noted in two patients between 7th-10th day requiring additional immunosuppressants or steroids.
PP used as an adjunct therapy in severe, progressive NPSLE is well tolerated and can turn the patient around. PP should be followed by synchronized pulse CPM to prevent disease flare.
我们报告了使用血浆置换（PP）作为重症进行性神经精神性系统性红斑狼疮（NPSLE）辅助治疗的经验。
3例NPSLE患者（包括2例癫痫持续状态患者），在使用类固醇或脉冲环磷酰胺（CPM）与类固醇联合治疗后病情仍逐渐恶化，先接受PP治疗，随后进行同步CPM治疗。治疗前后进行了系统性红斑狼疮疾病活动指数（SLEDAI）及实验室检查。
PP治疗后立即出现显著临床改善，SLEDAI降低。PP治疗前后SLEDAI平均值分别为33和11。红细胞沉降率平均值从121降至31。2例患者在第7至10天出现疾病活动反弹，需要额外的免疫抑制剂或类固醇治疗。
PP作为重症进行性NPSLE的辅助治疗耐受性良好，且能使患者病情好转。PP治疗后应同步进行脉冲CPM以预防疾病复发。
