Liang Xiaowan, Zhang Chen, Xue Jun, Zheng Yin
Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Nursing Department, Huashan Hospital, Fudan University, Shanghai, China.
BMC Neurol. 2024 Dec 6;24(1):475. doi: 10.1186/s12883-024-03971-y.
Whether double filtration plasmapheresis (DFPP) is effective in the patients who do not response to the initial immunotherapy is uncertain. This retrospective study aimed to evaluate the efficacy and safety of DFPP in the treatment of patients who had no improvement after initial immunotherapy (steroids and/or immunoglobulin (IVIG)), and moreover, to investigate the factors associated with the efficacy of DFPP.
From January 1st, 2014, to December 30th,2018, a total of 26 patients who were diagnosed autoimmune encephalitis (AE) and were received the treatment of DFPP after unsuccessful or incomplete recovery from their early immune therapy (including intravenous high-dose cortisone, IVIG and or immunosuppressant) for at least 21 days were investigated. Their plasmapheresis volume, the course of disease, treatment sessions, and complications were recorded. The efficacy of DFPP within a week were assessed by modified Rankin scale (mRS). These patients were followed until six months after the last session of DFPP treatment.
The duration between the onset of symptoms and DFPP administration was 54.5 days (range 21-243 days). The median DFPP sessions for each patient were three (range 2-6 sessions), and the mean volume of plasma exchange was 50.5 ± 11.1 ml/kg/session. Total clinically relevant improvement was observed in 57.7% of the patients. The median mRS was decreased from 5 to 4 within one week after DFPP treatment (P < 0.001). Only one patient relapsed in the following six months after DFPP. The effectiveness of DFPP has no relationship with age, gender, the type of antibody, with or without neoplasm, clinical course and the volume of plasma exchange. Most patients tolerated well, except 2 cases. One encountered mild allergic reaction and the other had a transient hypotension during DFPP treatment, but both were corrected rapidly.
DFPP is an effective and safe treatment option for patients who have poor responsiveness to early immunotherapy).
双重过滤血浆置换（DFPP）对初始免疫治疗无反应的患者是否有效尚不确定。这项回顾性研究旨在评估DFPP治疗初始免疫治疗（类固醇和/或免疫球蛋白（IVIG））后无改善的患者的疗效和安全性，此外，还研究与DFPP疗效相关的因素。
对2014年1月1日至2018年12月30日期间，共26例被诊断为自身免疫性脑炎（AE）且在早期免疫治疗（包括静脉注射大剂量皮质类固醇、IVIG和/或免疫抑制剂）至少21天治疗失败或恢复不完全后接受DFPP治疗的患者进行了调查。记录他们的血浆置换量、病程、治疗次数和并发症。采用改良Rankin量表（mRS）评估DFPP在一周内的疗效。对这些患者进行随访，直至DFPP治疗最后一次疗程后6个月。
症状出现至进行DFPP治疗的时间为54.5天（范围21 - 243天）。每位患者DFPP治疗的中位数为3次（范围2 - 6次），平均血浆置换量为50.5±11.1ml/kg/次。57.7%的患者观察到临床相关的总体改善。DFPP治疗后一周内，mRS中位数从5降至4（P < 0.001）。DFPP治疗后的六个月内只有1例患者复发。DFPP的有效性与年龄、性别、抗体类型、有无肿瘤、临床病程及血浆置换量无关。除2例患者外，大多数患者耐受性良好。1例在DFPP治疗期间出现轻度过敏反应，另1例出现短暂性低血压，但均迅速得到纠正。
DFPP是对早期免疫治疗反应不佳的患者的一种有效且安全的治疗选择。
