Lin Jui-Hsiang, Tu Kun-Hua, Chang Chih-Hsiang, Chen Yung-Chang, Tian Ya-Chung, Yu Chun-Chen, Hung Cheng-Chieh, Fang Ji-Tseng, Yang Chih-Wei, Chang Ming-Yang
Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Ministry of Health and Welfare, Tao Yuan General Hospital, Taoyuan, Taiwan.
Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Transfus Apher Sci. 2015 Feb;52(1):78-83. doi: 10.1016/j.transci.2014.12.005. Epub 2014 Dec 17.
Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating polyradiculoneuropathy that could lead to disabilities if not properly treated. There are only limited data on the prognostic factors and complications when using double-filtration plasmapheresis in these patients. We reviewed the medical records of 60 GBS patients who underwent double-filtration plasmapheresis as the first-line therapy at a tertiary care teaching hospital. The severity of disease was evaluated at different time points using disability scores. Functional outcome was defined as good (GBS disability score 0 to 2) or poor (GBS disability score 3 to 6) at 28 days after admission. The cohort included 22 women and 38 men with a mean age of 50 ± 18 years. In univariate logistic regression analysis, potential factors associated with poor outcome include an older age (P = 0.101), the absence of preceding respiratory tract infection (P = 0.043), mechanical ventilation (P = 0.016), a lower hematocrit (p = 0.072), a lower serum sodium level (P = 0.153) and a higher disability score on admission (P < 0.001). In multivariate analysis, a higher disability score on admission was associated with a poorer outcome (OR, 5.61; 95% CI, 2.34 to 13.43; P < 0.001), whereas the presence of prodromal upper respiratory tract infection correlated with a better outcome (OR, 0.13; 95% CI, 0.03-0.59; P = 0.009). Among 60 patients, eleven (18.3%) have various complications attributed to plasmapheresis treatment. Six patients (10.0%) developed deep vein thrombosis and two experienced catheter-related infection (3.3%). Hypotension, allergy and hemolysis occurred in one patient each (1.7%). In conclusion, we describe our experiences of using DFPP in the treatment of GBS. The pretreatment severity score was the most significant predictor of treatment outcome, suggesting that early referral and timely treatment are important. Potential complications such as catheter-related infection and deep vein thrombosis should be monitored carefully.
吉兰-巴雷综合征（GBS）是一种急性免疫介导的脱髓鞘性多发性神经根神经病，若治疗不当可导致残疾。关于这些患者使用双重滤过血浆置换术时的预后因素和并发症的数据有限。我们回顾了一家三级护理教学医院中60例接受双重滤过血浆置换术作为一线治疗的GBS患者的病历。使用残疾评分在不同时间点评估疾病严重程度。功能结局定义为入院28天后良好（GBS残疾评分为0至2）或不良（GBS残疾评分为3至6）。该队列包括22名女性和38名男性，平均年龄为50±18岁。在单因素逻辑回归分析中，与不良结局相关的潜在因素包括年龄较大（P = 0.101）、无先前呼吸道感染（P = 0.043）、机械通气（P = 0.016）、血细胞比容较低（p = 0.072）、血清钠水平较低（P = 0.153）和入院时残疾评分较高（P < 0.001）。在多因素分析中，入院时较高的残疾评分与较差的结局相关（OR，5.61；95%CI，2.34至13.43；P < 0.001），而前驱上呼吸道感染的存在与较好的结局相关（OR，0.13；95%CI，0.03 - 0.59；P = 0.009）。在60例患者中，11例（18.3%）出现了归因于血浆置换治疗的各种并发症。6例患者（10.0%）发生了深静脉血栓形成，2例经历了导管相关感染（3.3%）。低血压、过敏和溶血各发生1例（1.7%）。总之，我们描述了我们使用双重滤过血浆置换术治疗GBS的经验。治疗前严重程度评分是治疗结局的最显著预测因素，表明早期转诊和及时治疗很重要。应仔细监测诸如导管相关感染和深静脉血栓形成等潜在并发症。
