Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.
Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.
Dev Med Child Neurol. 2018 Aug;60(8):765-779. doi: 10.1111/dmcn.13925. Epub 2018 Jun 1.
Therapeutic plasma exchange (TPE) has been a key immunotherapeutic strategy in numerous neurological syndromes, predominantly during the acute phase of illness. This paper reviews the indications, strength of evidence, and safety of TPE in children with neurological conditions. The rarity of these immune conditions in children, alongside an often incomplete understanding of their pathobiology, has limited the development of a robust scientific rationale for TPE therapy and the feasibility of conducting larger controlled trials. TPE continues to be used, but is a costly therapy with common adverse effects. Uncertainty remains over how to compare the different TPE methods, the optimal dosage of therapy, and monitoring and integration of TPE with other immunotherapies. Further studies are also required to define the indications and benefits of TPE and assess evolving technologies such as immunoadsorption.
Studies investigating therapeutic plasma exchange (TPE) are small and mainly uncontrolled. They provide evidence for the efficacy of TPE in childhood neuro-inflammatory conditions. TPE is generally well tolerated provided key adverse effects are anticipated and avoided. Systematic dosing and objective assessment of treatment effect should be priorities for future research.
治疗性血浆置换（TPE）在许多神经综合征中是一种重要的免疫治疗策略，主要在疾病的急性期进行。本文综述了 TPE 在儿科神经疾病中的适应证、证据强度和安全性。由于这些免疫性疾病在儿童中较为罕见，且对其发病机制的认识常常不完整，因此限制了 TPE 治疗的强有力科学依据的发展，也限制了进行更大规模对照试验的可行性。TPE 仍在使用，但费用较高，且有常见的不良反应。如何比较不同的 TPE 方法、治疗的最佳剂量以及 TPE 与其他免疫疗法的监测和整合，仍存在不确定性。还需要进一步的研究来确定 TPE 的适应证和益处，并评估免疫吸附等新兴技术。
研究 TPE 的小型研究主要是无对照研究。它们为 TPE 在儿童神经炎症性疾病中的疗效提供了证据。只要预期并避免了关键的不良反应，TPE 通常是可以耐受的。系统的剂量和对治疗效果的客观评估应该是未来研究的重点。
