40年经验：重症肌无力、格林-巴利综合征及其他免疫介导性神经疾病的治疗性血浆置换

Therapeutic plasma exchange for myasthenia gravis, Guillain-Barre syndrome, and other immune-mediated neurological diseases, over a 40-year experience.

作者信息

Fernández-Fournier Mireya, Kerguelen Ana, Rodríguez de Rivera Francisco Javier, Lacruz Laura, Jimeno Santiago, Losantos Itsaso, Hernández-Maraver Dolores, Puertas Inmaculada, Tallon-Barranco Antonio, Viejo Aurora, Frank García Ana, Díez-Tejedor Exuperio

机构信息

Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain.

Apheresis Unit, Department of Haematology, Hospital Universitario La Paz, Spain.

出版信息

Expert Rev Neurother. 2022 Oct;22(10):897-903. doi: 10.1080/14737175.2022.2147827. Epub 2022 Nov 30.

DOI:10.1080/14737175.2022.2147827

PMID:36408604

Abstract

BACKGROUND

Therapeutic plasma exchange (TPE) was first used in neurology in the 1980s for myasthenia gravis (MG) and Guillain-Barré syndrome (GBS). Indications have since grown. Fear of complications with this treatment modality limit its use.

RESEARCH DESIGN & METHODS: A study of patients undergoing TPE for neurological diseases (1981-2020) in a University Hospital in Madrid, Spain. Clinical indications, complications, procedure number, apheresis technique and replacement fluids were prospectively recorded and retrospectively analyzed. Historical trends were studied.

RESULTS

159 patients (48.69 ±18.15 years, 54.3% females) underwent TPE using central-venous catheter and replacement fluid albumin. We performed 1207 procedures over 189 cycles (6.4 ±3.8 procedures/cycle). Most patients underwent TPE for category I-II indications, mainly GBS and MG (77.7%). Complication rate was low (3.9% procedures), mostly hypotensive/vasovagal reactions (55.3%) and vascular access-related complications (38.3%). Most were mild-moderate (92.9%), permitting TPE completion, and somewhat more frequent during the first procedure (38.3%) and after periods of little TPE use. GBS patients were more prone to complications than MG patients (6.5% vs. 1.2%,p<0.001) mainly hypotensive/vasovagal reactions (3.7% vs. 1.0%,p=0.008).

CONCLUSIONS

TPE is well-tolerated with low complication rate (<4% procedures), mainly hypotensive/vasovagal reactions. Patients with GBS seem more prone to them than MG patients. Acquaintance with this technique seems necessary.

摘要

背景

治疗性血浆置换（TPE）于20世纪80年代首次在神经病学领域用于治疗重症肌无力（MG）和吉兰-巴雷综合征（GBS）。此后其适应证不断增加。对这种治疗方式并发症的担忧限制了其应用。

研究设计与方法

对西班牙马德里一家大学医院中因神经系统疾病接受TPE治疗的患者（1981 - 2020年）进行研究。前瞻性记录并回顾性分析临床适应证、并发症、治疗次数、血液分离技术和置换液情况。研究历史趋势。

结果

159例患者（年龄48.69±18.15岁，54.3%为女性）使用中心静脉导管和置换液白蛋白进行了TPE治疗。我们在189个周期内进行了1207次治疗（6.4±3.8次治疗/周期）。大多数患者因I-II类适应证接受TPE治疗，主要是GBS和MG（77.7%）。并发症发生率较低（3.9%的治疗），主要是低血压/血管迷走神经反应（55.3%）和血管通路相关并发症（38.3%）。大多数并发症为轻-中度（92.9%），允许完成TPE治疗，且在首次治疗期间（38.3%）和较少使用TPE一段时间后更为常见。GBS患者比MG患者更容易出现并发症（6.5%对1.2%，p<0.001），主要是低血压/血管迷走神经反应（3.7%对1.0%，p = 0.008）。