Kaplan A A, Halley S E
Department of Medicine, University of Connecticut School of Medicine, Farmington.
Kidney Int. 1990 Jul;38(1):160-6. doi: 10.1038/ki.1990.181.
We have modified a rotating filter system to provide therapeutic plasma exchange. Seventeen patients underwent 188 treatments. Blood flows to the filter ranged from 75 to 100 ml/min; mean filtration fraction was 64 +/- 1% (+/- SE, N = 188). Mean plasma removal rate per treatment was 40.2 +/- 0.6 ml/min; net plasma removed per treatment was 3231 +/- 53 ml (N = 188); mean treatment time was 83 +/- 2 minutes (N = 188). Mean percent decline in platelet count was 15 +/- 4% (N = 46). Immunoglobulin kinetics were evaluated in order to validate our method of treatment prescription. The apparent volume of distribution (AVD) for each immunoglobulin class was compared to our estimate for plasma volume (EPV). The fraction AVD/EPV for IgG was 0.97 +/- 0.04 (N = 14), for IgA was 0.87 +/- 0.04 (N = 13) and for IgM was 0.96 +/- 0.3 (N = 26). Use of the EPV allowed for accurate prediction of treatment results. Correlation between expected and actual decline in serum levels revealed an r value of 0.86 for IgG (P = 0.0002), 0.88 for IgA (P = 0.0001), and 0.57 for IgM (P less than 0.003). We conclude that a rotating filter system can provide a highly efficient means of plasma exchange. The use of a simplified method of estimating plasma volume allows for a reliable prediction of treatment results.
我们改良了一种旋转过滤系统以进行治疗性血浆置换。17例患者接受了188次治疗。流向过滤器的血流量为75至100毫升/分钟；平均滤过分数为64±1%（±标准误，N = 188）。每次治疗的平均血浆清除率为40.2±0.6毫升/分钟；每次治疗净清除血浆量为3231±53毫升（N = 188）；平均治疗时间为83±2分钟（N = 188）。血小板计数的平均下降百分比为15±4%（N = 46）。为验证我们的治疗处方方法，对免疫球蛋白动力学进行了评估。将每种免疫球蛋白类别的表观分布容积（AVD）与我们对血浆容积（EPV）的估计值进行比较。IgG的AVD/EPV分数为0.97±0.04（N = 14），IgA为0.87±0.04（N = 13），IgM为0.96±0.3（N = 26）。使用EPV可准确预测治疗结果。血清水平预期下降与实际下降之间的相关性显示，IgG的r值为0.86（P = 0.0002），IgA为0.88（P = 0.0001），IgM为0.57（P＜0.003）。我们得出结论，旋转过滤系统可提供一种高效的血浆置换方法。使用简化的血浆容积估计方法可可靠地预测治疗结果。
