Rock G A, Shumak K H, Buskard N A, Blanchette V S, Kelton J G, Nair R C, Spasoff R A
Department of Medicine, University of Ottawa, Ont., Canada.
N Engl J Med. 1991 Aug 8;325(6):393-7. doi: 10.1056/NEJM199108083250604.
Thrombotic thrombocytopenic purpura is an uncommon disease with a high mortality rate even with current treatment. The cause of the syndrome and its optimal treatment are unknown. Although both plasma exchange and plasma infusion have been useful treatments, it is not clear which is superior. In this report we describe a prospective randomized trial comparing plasma exchange with plasma infusion for the treatment of thrombotic thrombocytopenic purpura.
One hundred two patients with thrombotic thrombocytopenic purpura were randomly assigned to receive either plasma exchange or plasma infusion with fresh-frozen plasma on seven of the first nine days after entry into the trial. The total volume of plasma received by patients undergoing plasma exchange was three times that received by patients undergoing plasma infusion. All the patients also received aspirin and dipyridamole. The outcomes in the two groups were compared at the end of the first treatment cycle (day 9) and after six months.
At the end of the first treatment cycle patients receiving plasma exchange had a higher rate of response as defined by an increase in the platelet count (24 of 51 patients) than those who received plasma infusion (13 of 51, P = 0.025). Of the 51 patients treated with plasma exchange, 2 died, whereas 8 of the 51 patients who received plasma infusion died (P = 0.035). After six months the outcome in the plasma-exchange group was still superior, with a response observed in 40 of 51 patients, whereas 25 of 51 patients in the plasma-infusion group responded (P = 0.002). Eleven patients in the plasma-exchange group died, as did 19 patients in the plasma-infusion group (P = 0.036). The overall mortality was 29 percent.
Plasma exchange is more effective than plasma infusion in the treatment of thrombotic thrombocytopenic purpura.
血栓性血小板减少性紫癜是一种罕见疾病，即便采用当前治疗方法，死亡率仍很高。该综合征的病因及其最佳治疗方法尚不清楚。虽然血浆置换和血浆输注都是有效的治疗方法，但尚不清楚哪种方法更优。在本报告中，我们描述了一项前瞻性随机试验，比较血浆置换与血浆输注治疗血栓性血小板减少性紫癜的效果。
102例血栓性血小板减少性紫癜患者在进入试验后的前九天中的七天，被随机分配接受血浆置换或输注新鲜冷冻血浆。接受血浆置换的患者所接受的血浆总量是接受血浆输注患者的三倍。所有患者还接受了阿司匹林和双嘧达莫治疗。在第一个治疗周期结束时（第9天）和六个月后比较两组的治疗结果。
在第一个治疗周期结束时，接受血浆置换的患者中，血小板计数增加定义的缓解率（51例患者中的24例）高于接受血浆输注的患者（51例中的13例，P = 0.025）。在接受血浆置换治疗的51例患者中，2例死亡，而接受血浆输注的51例患者中有8例死亡（P = 0.035）。六个月后，血浆置换组的治疗结果仍然更好，51例患者中有40例有反应，而血浆输注组的51例患者中有25例有反应（P = 0.002）。血浆置换组有11例患者死亡，血浆输注组有19例患者死亡（P = 0.036）。总死亡率为29%。
在治疗血栓性血小板减少性紫癜方面，血浆置换比血浆输注更有效。
