Darmon Michael, Azoulay Elie, Thiery Guillaume, Ciroldi Magali, Galicier Lionel, Parquet Nathalie, Veyradier Agnès, Le Gall Jean-Roger, Oksenhendler Eric, Schlemmer Benoît
Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Saint-Louis University Hospital, Paris, France.
Crit Care Med. 2006 Aug;34(8):2127-33. doi: 10.1097/01.CCM.0000227659.14644.3E.
Few studies have investigated adults with thrombotic microangiopathy (TMA) requiring intensive care unit (ICU) admission, and the treatment remains controversial.
To describe causes, outcomes, prognostic factors, and daily organ-failure score changes in adults with TMA requiring ICU admission.
A 3-yr single-center cohort study.
The patients were 36 adults with TMA admitted to a teaching-hospital medical ICU between January 2000 and June 2003.
Of the 36 patients, 22 received plasma infusion and 15 underwent plasma exchange. All patients had anemia and thrombocytopenia at ICU admission, and 13 had neurologic impairment. Median creatinine clearance was 55.2 mL/min (interquartile range, 28.8-75.4). No patient had congenital TMA. Causative factors included microbiologically documented infection in 14 patients, allogeneic transplantation in 7 patients, and concomitant or subsequent systemic disease in 7 patients; 6 patients were human immunodeficiency virus-positive, 5 had drug-induced TMA, 2 were pregnant, and 2 had cancer. In 10 patients, no causative factors were identified. Plasma exchange was associated with a statistically significant decrease in hospital mortality (0 vs. 7 deaths; p < .001). Moreover, daily organ-failure scores were significantly lower in the plasma-exchange group from day 3 to day 9. Patients in the plasma-exchange group received a larger volume of plasma.
Plasma exchange may be associated with faster resolution of organ failure and with improved survival for patients with TMA requiring ICU admission.
很少有研究调查需要入住重症监护病房（ICU）的血栓性微血管病（TMA）成人患者，其治疗仍存在争议。
描述需要入住ICU的TMA成人患者的病因、结局、预后因素及每日器官衰竭评分变化。
一项为期3年的单中心队列研究。
2000年1月至2003年6月期间入住一家教学医院内科ICU的36例TMA成人患者。
36例患者中，22例接受了血浆输注，15例接受了血浆置换。所有患者入住ICU时均有贫血和血小板减少，13例有神经功能损害。肌酐清除率中位数为55.2 mL/分钟（四分位间距，28.8 - 75.4）。无患者患有先天性TMA。病因包括14例微生物学证实的感染、7例异体移植、7例合并或随后发生的全身性疾病；6例患者为人类免疫缺陷病毒阳性，5例为药物性TMA，2例为孕妇，2例患有癌症。10例患者未发现病因。血浆置换与医院死亡率的统计学显著降低相关（0例死亡 vs. 7例死亡；p < 0.001）。此外，从第3天到第9天，血浆置换组的每日器官衰竭评分显著更低。血浆置换组患者接受的血浆量更大。
血浆置换可能与需要入住ICU的TMA患者器官衰竭的更快缓解及生存率提高相关。
