Guillevin Loïc, Pagnoux Christian
Department of Internal Medicine, Referral Center for Rare Diseases, Vasculitis and Scleroderma, Hôpital Cochin, AP-HP, Université de Paris René-Descartes, 27, rue du Faubourg Saint-Jacques, Paris, France.
Transfus Apher Sci. 2007 Apr;36(2):179-85. doi: 10.1016/j.transci.2007.01.006.
Plasma exchanges (PE) are a component of regimens prescribed to treat systemic necrotizing vasculidities. They are also part of the best therapeutic strategy for virus-induced vasculidities. The combination of antiviral agents and PE has proven efficacy against polyarteritis nordosa. This strategy is also effective for human immunodeficiency virus-associated vasculitis and, unlike cytotoxic agents, does not jeopardize the outcome of acquired immunodeficiency syndrome. Concerning the vasculitis seen in the context of hepatitis C virus-related cryoglobulinemia, PE contribute to better outcomes but, because of the poor efficacies of antiviral drugs, only about half of the patients achieve definitive recovery and relapses are frequent. The use of PE to treat antineutrophil cytoplasm antibody-associated vasculidities with severe renal insufficiency leads to improved renal function and thus fewer patients require dialysis. Although PE does not improve survival, their adjunction to corticosteroids and immunosuppressants for patients with alveolar hemorrhage could also limit the severity of this severe manifestation.
血浆置换（PE）是用于治疗系统性坏死性血管炎的治疗方案的组成部分。它们也是病毒诱导性血管炎最佳治疗策略的一部分。抗病毒药物与血浆置换联合使用已被证明对结节性多动脉炎有效。该策略对人类免疫缺陷病毒相关血管炎也有效，并且与细胞毒性药物不同，不会危及获得性免疫缺陷综合征的预后。关于丙型肝炎病毒相关冷球蛋白血症背景下出现的血管炎，血浆置换有助于改善预后，但由于抗病毒药物疗效不佳，只有约一半的患者能实现彻底康复，且复发频繁。使用血浆置换治疗伴有严重肾功能不全的抗中性粒细胞胞浆抗体相关血管炎可改善肾功能，因此需要透析的患者减少。虽然血浆置换不能提高生存率，但对于肺泡出血患者，将其与皮质类固醇和免疫抑制剂联合使用也可减轻这种严重表现的严重程度。
