Margulis E Ia, Savchenko V G, Vasil'ev S A, Gorodetskiĭ V M, Ryzhko V V
Ter Arkh. 1985;57(7):125-31.
The authors analyse the efficacy of extracorporeal heparin precipitation of plasma proteins (selective plasmapheresis) in patients with immune complex pathology. The method lies in extracorporeal precipitation at +4 degrees C of fibronectin, cryofibrinogen and other macromolecular complexes with the aid of heparin, followed by plasma return to the patient. The method was applied to 39 patients. Hemorrhagic microthrombovasculitis was diagnosed in 7, vasculitis paralleled by hepatosplenomegaly of unclear genesis in 1, generalized vasculitis with marked systemic manifestations in 1, immune complex vasculitis complicated by recurrent polychondritis in 1, chronic active hepatitis associated with immune complex vasculitis in 1, rheumatoid arthritis in 8, systemic lupus erythematosus in 4, spleen lymphoma and Sjögren's syndrome in 1, idiopathic amyloidosis in 2, multiple sclerosis in 10 patients. Altogether 309 sessions of selective plasmaphapheresis were carried out. The time course of the clinical and laboratory criteria of the disease activity were studied before and after each plasmapheresis session. It was ascertained that the method is highly effective in the treatment of hemorrhagic vasculitis. It is mostly used if conventional therapy with heparin, cryoplasm, and deaggregating agents appears abortive. Apparently, it is the only method that may rapidly arrest the abdominal syndrome associated with hemorrhagic vasculitis. The possibility and advisability of the use of chronic plasmapheresis are discussed. Application of the method to the treatment of rheumatoid arthritis permits reducing the dose of steroid hormones, thereby not stimulating the disease activity. The method is the therapy of choice in different diseases associated with polyvalent allergy. In amyloidosis and multiple sclerosis, the method efficacy is questionable.(ABSTRACT TRUNCATED AT 250 WORDS)
作者分析了体外肝素沉淀血浆蛋白（选择性血浆置换）在免疫复合物病患者中的疗效。该方法是在4℃下借助肝素对纤连蛋白、冷纤维蛋白原及其他大分子复合物进行体外沉淀，随后将血浆回输给患者。该方法应用于39例患者。其中7例诊断为出血性微血管炎，1例为病因不明的肝脾肿大伴发的血管炎，1例为有明显全身表现的全身性血管炎，1例为免疫复合物性血管炎并发复发性多软骨炎，1例为与免疫复合物性血管炎相关的慢性活动性肝炎，8例为类风湿关节炎，4例为系统性红斑狼疮，1例为脾淋巴瘤和干燥综合征，2例为特发性淀粉样变性，10例为多发性硬化症。共进行了309次选择性血浆置换治疗。在每次血浆置换治疗前后研究了疾病活动的临床和实验室指标的时间进程。确定该方法在治疗出血性血管炎方面非常有效。如果肝素、冷沉淀物和抗聚集剂的常规治疗无效，大多会使用该方法。显然，这是唯一能迅速缓解与出血性血管炎相关的腹部综合征的方法。讨论了慢性血浆置换使用的可能性和可取性。将该方法应用于类风湿关节炎的治疗可减少类固醇激素的剂量，从而不会刺激疾病活动。该方法是治疗与多价过敏相关的不同疾病的首选疗法。在淀粉样变性和多发性硬化症中，该方法的疗效值得怀疑。（摘要截短为250字）
