1996 年至 2011 年，接受血栓性血小板减少性紫癜-溶血尿毒综合征治疗的患者中，血浆置换并发症的发生频率降低。
Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011.
机构信息
Department of Biostatistics and Epidemiology, College of Public Health, Department of Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, USA.
出版信息
Transfusion. 2012 Dec;52(12):2525-32; quiz 2524. doi: 10.1111/j.1537-2995.2012.03646.x. Epub 2012 Apr 15.
BACKGROUND
Plasma exchange (PEX) treatment for patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has risk for major complications.
STUDY DESIGN AND METHODS
Data for PEX-related complications have been prospectively collected on all patients enrolled in the Oklahoma TTP-HUS Registry, 1996 to 2011. PEX-related complications have been defined as major or minor and as central venous catheter related or plasma related.
RESULTS
During 15 years, 1996 to 2011, 72 (24%) of 302 consecutive patients had major PEX-related complications. Analysis of five consecutive 3-year cohorts demonstrated that there has been a significant trend for decreasing frequency of all PEX-related major complications (p = 0.014) and central venous catheter-related major complications (p = 0.021) but not for the less common plasma-related major complications (p = 0.380). ADAMTS13 activity was measured in 288 (95%) of the 302 patients. Analysis of the 66 patients with ADAMTS13 activity of less than 10% demonstrated a significant trend for decreasing frequency of PEX-related major complications (p = 0.036); the trend for the 222 patients with ADAMTS13 activity of at least 10% was not significant (p = 0.118). The decreased frequency of PEX-related major complications among patients with ADAMTS13 activity of less than 10% may be related to a significant trend for decreasing duration of PEX treatment (p = 0.040) and decreasing frequency of requirement for more than one central venous catheter (p = 0.044). The decreased duration of PEX treatment may be related to increased use of adjunctive treatments: corticosteroids (p < 0.001) and rituximab (p < 0.001).
CONCLUSIONS
The frequency of PEX-related major complications has decreased from 1996 to 2011, possibly related to increased use of corticosteroids and rituximab and the decreased duration of PEX required to achieve remission.
背景
对于血栓性血小板减少性紫癜-溶血尿毒综合征（TTP-HUS）患者，进行血浆置换（PEX）治疗存在发生重大并发症的风险。
研究设计和方法
自 1996 年至 2011 年，前瞻性收集了所有入组俄克拉荷马 TTP-HUS 登记处的患者的 PEX 相关并发症数据。将 PEX 相关并发症定义为主要或次要并发症，以及与中心静脉导管相关或与血浆相关的并发症。
结果
在 1996 年至 2011 年的 15 年期间，302 例连续患者中有 72 例（24%）发生了主要的 PEX 相关并发症。对连续 3 年的 5 个队列进行分析，显示所有 PEX 相关主要并发症（p=0.014）和与中心静脉导管相关的主要并发症（p=0.021）的频率呈显著下降趋势，但不太常见的与血浆相关的主要并发症（p=0.380）的频率没有明显下降。在 302 例患者中，有 288 例（95%）检测了 ADAMTS13 活性。对 ADAMTS13 活性小于 10%的 66 例患者进行分析，发现 PEX 相关主要并发症的频率呈显著下降趋势（p=0.036）；而对 ADAMTS13 活性至少为 10%的 222 例患者，这种趋势没有统计学意义（p=0.118）。ADAMTS13 活性小于 10%的患者中 PEX 相关主要并发症的频率降低，可能与 PEX 治疗持续时间的显著缩短（p=0.040）和需要更换中心静脉导管的频率降低（p=0.044）有关。PEX 治疗持续时间的缩短可能与辅助治疗的使用增加有关：皮质类固醇（p<0.001）和利妥昔单抗（p<0.001）。
结论
自 1996 年至 2011 年，PEX 相关主要并发症的频率有所下降，这可能与皮质类固醇和利妥昔单抗的使用增加以及达到缓解所需的 PEX 治疗时间缩短有关。
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