Momtaz Mohamed, Fayed Ahmed, Marzouk Khaled, Shaker Amr
Department of Internal Medicine, Nephrology Unit, Cairo University Hospital, Cairo, Egypt.
Ther Apher Dial. 2018 Dec;22(6):666-673. doi: 10.1111/1744-9987.12710. Epub 2018 Jul 15.
Therapeutic plasma exchange is used in treating different immunological and non-immunological diseases. We analyzed the outcome of 308 patients treated by 1783 membrane plasma exchange sessions from January 2011 until January 2017 at Cairo University Hospital. Thrombotic microangiopathies were the commonest indication [73 (23.7%) patients] with response in 63/73 patients (86.3%), followed by systemic vasculitis with pulmonary-renal involvement [40(13%) patients] with recovery in 32/40 patients (80.0%), Guillain-Barré syndrome [39(12.7%) patients] with recovery in 30/39 patients (76.9%), myasthenia gravis [31(10.1%) patients] with response in 26/31 patients (83.9%), and catastrophic antiphospholipid syndrome [28(9.1%) patients] with recovery in only 6/28 patients (21.4%). Complications included hypotension [276/1783 (15.5%) sessions], hypocalcemia [26/308 (8.5%) patients], and 37/308 (12%) patients died. Sepsis caused mortality in 29/37 (78.4%) of patients. In conclusion, our therapeutic plasma exchange experience shows a favorable outcome for thrombotic microangiopathies, systemic vasculitis, myasthenia gravis, and Guillain-Barré syndrome. Sepsis was the leading mortality cause.
治疗性血浆置换用于治疗不同的免疫性和非免疫性疾病。我们分析了2011年1月至2017年1月在开罗大学医院接受1783次膜式血浆置换治疗的308例患者的治疗结果。血栓性微血管病是最常见的适应证[73例（23.7%）患者]，63/73例患者（86.3%）有反应，其次是伴有肺肾受累的系统性血管炎[40例（13%）患者]，32/40例患者（80.0%）康复，吉兰-巴雷综合征[39例（12.7%）患者]，30/39例患者（76.9%）康复，重症肌无力[31例（10.1%）患者]，26/31例患者（83.9%）有反应，以及灾难性抗磷脂综合征[28例（9.1%）患者]，仅6/28例患者（21.4%）康复。并发症包括低血压[276/1783次（15.5%）治疗]、低钙血症[26/308例（8.5%）患者]，37/308例（12%）患者死亡。脓毒症导致37例患者中的29例（78.4%）死亡。总之，我们的治疗性血浆置换经验显示，血栓性微血管病、系统性血管炎、重症肌无力和吉兰-巴雷综合征的治疗效果良好。脓毒症是主要的死亡原因。
