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在多发性硬化症患者中进行治疗性血浆置换以对抗严重复发:在高容量中心的观察性分析。

Therapeutic plasma exchange in multiple sclerosis patients with an aggressive relapse: an observational analysis in a high-volume center.

机构信息

Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic.

Department of Clinical Neurosciences, Faculty of Medicine, University Ostrava, Ostrava, Czech Republic.

出版信息

Sci Rep. 2022 Nov 1;12(1):18374. doi: 10.1038/s41598-022-23356-w.

Abstract

An evidence-based treatment for a Multiple Sclerosis (MS) relapse is an intravenous administration of 3-5 g of Methylprednisolone. In case of insufficient effect or corticosteroids intolerance, the therapeutic plasma exchange (TPE) is indicated. To assess the clinical effect of TPE in treatment of relapse in patients with relapsing-remitting MS (RRMS), we enrolled 155 patients meeting the following criteria (study period: January 2011 to February 2021): (1) age > 18, (2) RRMS according to the McDonald´s 2017 criteria, (3) MS relapse and insufficient effect of corticosteroids/corticosteroids intolerance, (4) baseline EDSS < 8. Exclusion criteria: (1) progressive form of disease, (2) history of previous TPE. Following parameters were monitored: EDSS changes (before and after corticosteroid treatment, before and after TPE; EDSS after TPE was assessed at the next clinical follow-up at the MS Center), and improvement of EDSS according to the number of procedures and baseline severity of relapse. 115 females (74%) and 40 males (26%) were included. The median age was 41 years (IQR 33-47)-131 patients underwent the pulse corticosteroids treatment and TPE, while 24 patients underwent only TPE without any previous corticosteroid treatment. Median baseline EDSS was 4.5 (IQR 3.5-5.5), median EDSS after finishing steroids was 4.5 (IQR 4.0-5.5). EDSS prior to the TPE was 4.5 (IQR 4-6), EDSS after TPE was 4.5 (IQR 3.5-5.5). We observed a significant improvement in the EDSS after TPE (p < 0.001). Sex differences were seen in TPE effectiveness, with median improvement of EDSS in females being -0.5 (IQR 1-0) and in males being 0 (IQR -0.5 to 0), p = 0.048. There was no difference in EDSS improvement by age category: 18-30 years, 31-40 years, 41-50 years, > 50 (p = 0.94), nor by total TPE count (p = 0.91). In this retrospective study of patients with an aggressive relapse and insufficient effect of intravenous corticosteroid treatment, a significant effect of TPE on EDSS improvement was observed. There was no significant difference in TPE effectivity according to the number of procedures, age, nor severity of a relapse. In this cohort, TPE was more effective in females.

摘要

对于多发性硬化症(MS)复发,一种基于证据的治疗方法是静脉内给予 3-5g 甲基强的松龙。如果效果不佳或皮质类固醇不耐受,则需要进行治疗性血浆置换(TPE)。为了评估 TPE 在治疗复发缓解型多发性硬化症(RRMS)患者复发中的临床效果,我们纳入了符合以下标准的 155 名患者(研究期间:2011 年 1 月至 2021 年 2 月):(1)年龄>18 岁,(2)符合 2017 年 McDonald 多发性硬化症标准的 RRMS,(3)MS 复发和皮质类固醇效果不佳/皮质类固醇不耐受,(4)基线 EDSS<8。排除标准:(1)疾病进行性形式,(2)既往 TPE 史。监测以下参数:EDSS 变化(皮质类固醇治疗前后、TPE 治疗前后;TPE 后 EDSS 在 MS 中心下一次临床随访时进行评估),以及根据治疗次数和基线复发严重程度改善 EDSS。纳入 115 名女性(74%)和 40 名男性(26%)。中位年龄为 41 岁(IQR 33-47)-131 名患者接受脉冲皮质类固醇治疗和 TPE,而 24 名患者仅接受 TPE 而未接受任何既往皮质类固醇治疗。中位基线 EDSS 为 4.5(IQR 3.5-5.5),皮质类固醇治疗结束后 EDSS 中位数为 4.5(IQR 4.0-5.5)。TPE 前 EDSS 为 4.5(IQR 4-6),TPE 后 EDSS 为 4.5(IQR 3.5-5.5)。我们观察到 TPE 后 EDSS 显著改善(p<0.001)。TPE 效果存在性别差异,女性 EDSS 中位数改善为-0.5(IQR 1-0),男性为 0(IQR -0.5 至 0),p=0.048。按年龄类别(18-30 岁、31-40 岁、41-50 岁、>50 岁)、年龄(p=0.94)或 TPE 总次数(p=0.91)对 EDSS 改善无差异。在这项对静脉内皮质类固醇治疗效果不佳的侵袭性复发患者的回顾性研究中,我们观察到 TPE 对 EDSS 改善有显著效果。TPE 效果与治疗次数、年龄或复发严重程度无关。在本队列中,TPE 在女性中的效果更为显著。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd59/9626567/2a49a46c2348/41598_2022_23356_Fig1_HTML.jpg

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