Baweja Sanjeev, Wiggins Kate, Lee Darren, Blair Susan, Fraenkel Margaret, McMahon Lawrence P
Eastern Health, 5 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
J Artif Organs. 2011 Mar;14(1):9-22. doi: 10.1007/s10047-010-0529-5. Epub 2010 Dec 10.
In use for over 50 years, the rationale for plasmapheresis remains based largely on case series and retrospective studies. Recently, results from several randomized controlled trials, meta-analyses, and prospective studies have shown plasmapheresis may be of benefit in various renal diseases, and have provided insights into more rational use of this therapy. A multicenter trial by the European Vasculitis Study Group has shown it is the preferred additional form of therapy for patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and severe renal failure. A recent study conducted at Mayo Clinic also found it effective at reversing renal failure from myeloma-related cast nephropathy if serum free light chain levels were reduced by at least 50%. In addition, a Cochrane review has analyzed the available evidence for its use in thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. The objective of this article is to review recent and past evidence and, thereby, the current indications for treatment in renal disease.
血浆置换已应用超过50年，其理论依据很大程度上仍基于病例系列研究和回顾性研究。最近，多项随机对照试验、荟萃分析和前瞻性研究的结果表明，血浆置换可能对各种肾脏疾病有益，并为更合理地使用这种疗法提供了见解。欧洲血管炎研究组的一项多中心试验表明，对于抗中性粒细胞胞浆抗体相关性肾小球肾炎和严重肾衰竭患者，它是首选的辅助治疗形式。梅奥诊所最近进行的一项研究还发现，如果血清游离轻链水平至少降低50%，血浆置换可有效逆转骨髓瘤相关管型肾病导致的肾衰竭。此外，Cochrane系统评价分析了其用于血栓性血小板减少性紫癜和溶血尿毒综合征的现有证据。本文的目的是回顾过去和近期的证据，从而探讨目前肾脏疾病的治疗指征。
