吉兰-巴雷综合征和慢性炎症性脱髓鞘性多发性神经根神经病中的治疗性血浆置换

Therapeutic Plasma Exchange in Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy.

作者信息

Pham Huy P, Schwartz Joseph

机构信息

Keck School of Medicine of the University of Southern California, Department of Pathology, Los Angeles, CA, United States.

Columbia University Medical Center and the New York-Presbyterian Hospital, Department of Pathology and Cell Biology, New York, NY, United States.

出版信息

Presse Med. 2019 Nov;48(11 Pt 2):338-346. doi: 10.1016/j.lpm.2019.03.016. Epub 2019 Oct 31.

DOI:10.1016/j.lpm.2019.03.016

PMID:31679897

Abstract

Therapeutic plasma exchange (TPE) has been used as a treatment modality in many autoimmune disorders, including neurological conditions, such as Guillain-Barre syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The American Society for Apheresis (ASFA) publishes its guidelines on the use of therapeutic apheresis every 3 years based on published evidence to assist physicians with both the medical and technical aspects of apheresis consults. The ASFA Guidelines included the use of TPE in both GBS and CIDP as an acceptable first-line therapy, either alone and/or in conjunction with other therapeutic modalities. In this article, we briefly reviewed GBS and CIDP, discussed the role of apheresis in these conditions as well as various technical aspects of the TPE procedure, such as apheresis calculation, number of volume exchange, replacement fluid, and management of potential complications.

摘要

治疗性血浆置换（TPE）已被用作多种自身免疫性疾病的治疗方式，包括神经系统疾病，如吉兰-巴雷综合征（GBS）和慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）。美国单采学会（ASFA）每3年根据已发表的证据发布其关于治疗性血液成分单采使用的指南，以协助医生进行血液成分单采咨询的医学和技术方面的工作。ASFA指南将TPE用于GBS和CIDP均列为可接受的一线治疗方法，可单独使用和/或与其他治疗方式联合使用。在本文中，我们简要回顾了GBS和CIDP，讨论了血液成分单采在这些疾病中的作用以及TPE程序的各种技术方面，如血液成分单采计算、置换量、置换液以及潜在并发症的管理。