Iacono Salvatore, Schirò Giuseppe, Salemi Giuseppe, Scirè Elisabetta, Aridon Paolo, Melfa Michele, Andolina Michele, Sorbello Gabriele, Calì Andrea, Brighina Filippo, D'Amelio Marco, Ragonese Paolo
Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90129 Palermo, Italy.
Multiple Sclerosis Center, Foundation Institute G. Giglio, Cefalù, 90015 Palermo, Italy.
Neurol Int. 2024 Jul 10;16(4):761-775. doi: 10.3390/neurolint16040056.
Therapeutic plasma exchange (TPE) is a highly effective rescue treatment for patients with acute exacerbation of neuroimmunological disease that removes circulating autoantibodies and inflammatory components from the bloodstream. The aims of this study are to explore the safety and the effectiveness of TPE in patients with autoimmune neurological disorders.
We retrospectively evaluated the frequency of adverse events (AEs) and the effectiveness of TPE using the modified Ranking Scale (mRS) in patients with acute neurological flares who underwent TPE at the University Hospital of Palermo.
Of 59 patients, the majority underwent TPE due to multiple sclerosis (MS) relapse. In 23.7% of cases, TPE was performed before obtaining a definite diagnosis due to the severity of the clinical presentation. After TPE, the mRS score was globally reduced ( < 0.0001), and this effect was marked in patients with MS, Guillain-Barré syndrome, and myasthenia gravis crisis but not in those with paraneoplastic syndromes. Circulating pathogenetic antibodies, younger age, and the early use of TPE were factors strongly associated with TPE effectiveness. The overall safety profile of TPE was satisfactory with an AE frequency of 15%.
These results highlight the early use of TPE in patients with circulating pathogenetic antibodies as well as its favorable safety profile.
治疗性血浆置换（TPE）是治疗神经免疫性疾病急性加重患者的一种高效抢救疗法，可从血液中清除循环自身抗体和炎性成分。本研究旨在探讨TPE治疗自身免疫性神经系统疾病患者的安全性和有效性。
我们回顾性评估了巴勒莫大学医院接受TPE治疗的急性神经功能发作患者的不良事件（AE）发生频率以及使用改良Rankin量表（mRS）评估TPE的有效性。
59例患者中，大多数因多发性硬化症（MS）复发接受TPE治疗。在23.7%的病例中，由于临床表现严重，在获得明确诊断之前就进行了TPE治疗。TPE治疗后，mRS评分总体降低（<0.0001），这种效果在MS、吉兰-巴雷综合征和重症肌无力危象患者中明显，但在副肿瘤综合征患者中不明显。循环致病性抗体、年轻以及早期使用TPE是与TPE有效性密切相关的因素。TPE的总体安全性良好，AE发生率为15%。
这些结果突出了在有循环致病性抗体的患者中早期使用TPE及其良好的安全性。
