Ballestri Marco, Ferrari Federica, Magistroni Riccardo, Mariano Maria, Ceccherelli Giovanni Battista, Milanti Giorgio, De Palma Marisa, Albertazzi Alberto
Divisione e Cattedra di Nefrologia Dialisi e Trapianto Renale, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 79, 41100 Modena, Italy.
Ann Ist Super Sanita. 2007;43(2):171-5.
Therapeutic plasma exchange is an extra-corporeal technique able to remove from blood macromolecules and/or replace deficient plasma factors. It is the treatment of choice in hyperviscosity syndrome, due to the presence of quantitatively or qualitatively abnormal plasma proteins such as paraproteins. In spite of a general consensus on the indications to therapeutic plasma exchange in hyperviscosity syndrome, data or guide lines about the criteria to plan the treatment are still lacking. We studied the rheological effect of plasma exchange in 20 patients with plasma hyperviscosity aiming to give data useful for a rational planning of the treatment. Moreover, we verified the clinical applicability of the estimation of plasma viscosity by means of Kawai's equation. Plasma exchange decreases plasma viscosity about 20-30% for session. Only one session is required to normalize plasma viscosity when it is < 2.2 mPas, whereas a maximum of 3 session are required when it is > 2.2 till to 6 mPas. A fourth session is useless, especially if the inter-session interval is < 15 days. By means of a polynomial equation, knowing basal-plasma viscosity and the disease of a patient, we can calculate the decrease of viscosity obtainable by each session of plasma exchange then the number of session required to normalize the viscosity. Kawai's equation is able to evaluate plasma viscosity in healthy volunteers, but it is not clinically reliable in paraproteinemias.
治疗性血浆置换是一种体外技术，能够从血液中去除大分子物质和/或补充缺乏的血浆因子。它是高黏滞综合征的首选治疗方法，该综合征是由于存在定量或定性异常的血浆蛋白，如副蛋白。尽管对于高黏滞综合征中治疗性血浆置换的适应证已达成普遍共识，但关于制定治疗方案的标准的数据或指南仍然缺乏。我们研究了20例血浆高黏滞患者进行血浆置换的流变学效应，旨在提供有助于合理制定治疗方案的数据。此外，我们验证了通过河合方程估算血浆黏度的临床适用性。每次血浆置换可使血浆黏度降低约20% - 30%。当血浆黏度< 2.2 mPas时，仅需进行一次置换即可使其恢复正常，而当血浆黏度> 2.2直至6 mPas时，最多需要进行3次置换。第四次置换没有必要，尤其是当两次置换间隔< 15天时。通过一个多项式方程，了解患者的基础血浆黏度和疾病情况，我们可以计算出每次血浆置换可使黏度降低的值，进而计算出使黏度恢复正常所需的置换次数。河合方程能够评估健康志愿者的血浆黏度，但在副蛋白血症中其临床可靠性不足。
