Stebler C, Tichelli A, Dazzi H, Wernli M, Gratwohl A, Speck B
Departement Innere Medizin, Kantonsspital Basel.
Schweiz Med Wochenschr. 1991 Feb 2;121(5):145-9.
In 10 patients with Guillain-Barré syndrome the level of globulins and immunoglobulins before and after plasmapheresis was investigated. As a plasma substitute either PPL (in 8 patients) or a plasma substitute solution rich in immunoglobulins (in 2 patients) was used. When plasma was substituted with PPL, the globulins and immunoglobulins dropped to a mean of 40% of the initial value (range 30-60%) after the first plasmapheresis. With daily or alternate day plasmapheresis, the globulins only partially recovered. Before the second plasmapheresis they were still reduced to a mean of 50% (range 20-50%), and dropped further with ongoing exchanges to a mean of 33% (range 20-50%) as measured before the third plasmapheresis. Accordingly, there was a loss of immunoglobulins of similar magnitude. With the use of a plasma substitute solution rich in immunoglobulins (IRP), globulins could be maintained at normal levels. The lowest immunoglobulin values measured after plasmapheresis were 6 g/l (normal range 8-17 g/l). One patient developed gram-negative septicaemia after plasmapheresis with PPL, possibly due to a low immunoglobulin concentration. We conclude that a plasma substitute solution rich in immunoglobulins should be used for therapeutic plasmapheresis in order to maintain physiological immunoglobulin concentrations.
对10例吉兰 - 巴雷综合征患者进行了血浆置换前后球蛋白和免疫球蛋白水平的研究。作为血浆替代品，8例患者使用了人胎盘血丙种球蛋白（PPL），2例患者使用了富含免疫球蛋白的血浆替代溶液。当用PPL替代血浆时，第一次血浆置换后球蛋白和免疫球蛋白平均降至初始值的40%（范围30 - 60%）。每日或隔日进行血浆置换，球蛋白仅部分恢复。在第二次血浆置换前，它们仍降至平均50%（范围20 - 50%），随着持续置换，在第三次血浆置换前测量时进一步降至平均33%（范围20 - 50%）。相应地，免疫球蛋白也有类似程度的丢失。使用富含免疫球蛋白的血浆替代溶液（IRP）时，球蛋白可维持在正常水平。血浆置换后测得的最低免疫球蛋白值为6g/l（正常范围8 - 17g/l）。1例患者在使用PPL进行血浆置换后发生革兰氏阴性菌败血症，可能是由于免疫球蛋白浓度低所致。我们得出结论，为维持生理免疫球蛋白浓度，治疗性血浆置换应使用富含免疫球蛋白的血浆替代溶液。
