1700638169
(1)绝对适应证 ①为避免使用肾上腺皮质激素、免疫抑制剂(环孢菌素、硫唑嘌呤等)等的病例,尤其是合并糖尿病、骨质疏松、胃溃疡等的病例。②有肝功能、造血功能障碍的病例。
1700638170
1700638171
(2)相对适应证 ①即使长期大量使用上述药物,临床症状也没有得到改善的病例。②循环血液中存在大量自身抗体,病变范围广而严重的病例。
1700638172
1700638173
这一适应标准对寻常性天疱疮以外的皮肤病患者,在考虑进行血浆净化治疗时也可参考。
1700638174
1700638175
3.血浆净化的方法
1700638176
1700638177
可根据不同的疾病选择离心分离法、双重滤过法(DFPP法)、结合法(combination method)、免疫吸附法(ITR, IPH)。
1700638178
1700638179
4.血浆净化疗法的效果
1700638180
1700638181
表12-10总结了针对寻常性天疱疮(pemphigus vulgaris, PV)的血浆净化疗法的效果。目前日本对于治疗效果的判断标准依据为:①天疱疮抗体效价的变动;②临床症状的改善等;③肾上腺皮质激素的减量情况;④缓解期间长短;⑤副作用。表12-10显示了根据上述标准判断,在实施离心分离法、双重滤过法(DFPP法)、结合法(combination method)、免疫吸附法(ITR, IPH)后的治疗效果比较。除了IPH法以外,通过其他方法治疗后均观察到天疱疮抗体效价的减少,80%以上病例的临床症状得到改善。另外,对缓解的病例,在其后长期的观察中也未见复发的情况。同时,各种治疗方法实施后均未发现严重的副作用。
1700638182
1700638183
表12-10 寻常性天疱疮的血浆净化治疗效果
1700638184
1700638185
1700638186
1700638187
1700638188
【思考题】
1700638189
1700638190
1.简述血浆净化疗法治疗难治性疾病的原理。
1700638191
1700638192
2.血浆置换的原理、分类,并简述应用范围。
1700638193
1700638194
参考文献
1700638195
1700638196
[1] Kiprov DD, Hofmann JC. Plasapheresis in immunologically mediated polyneuropathies. Thyerap Apher Dial, 2003, 7(2)
:189-196.
1700638197
1700638198
[2] Nenov VD, Marinov P, Sabeva J, et al. Current applications of plasmapheresis in clinical toxicology. Nephrol Dial Transplant, 2003, 18 S5
:56-58.
1700638199
1700638200
[3] Braun-Moscovici Y, Furst DE. Plasmapheresis For Rheumatic diseases in the twenty-first century: take it or leave it? Curr Opin Rhermatol, 2003, 15(3)
:197-204.
1700638201
1700638202
[4] von Baeyer H. Plasmapheresis in thrombotic microangiopathy-associated syndromes: review of outcome data derived from clinical trials and open studies. Ther Apher, 2002, 6(4)
:320-328.
1700638203
1700638204
[5] Madore F. Plasmapheresis. Technical aspects and indications. Crit Care Clin, 2002, 18(2)
:375-392.
1700638205
1700638206
[6] Gaskin G, Pusey CD. Plasmapheresis in antineutrophil cytoplasmic antibody-associated systemic vasculitis. Ther Apher, 2001, 5(3)
:176-181.
1700638207
1700638208
[7] Rao PS, Bakir AA. The role of plasmapheresis in the treatment of focal segmental glomerulosclerosis(FSGS). Int J Artif Organs, 2000, 23(12)
:789-801.
1700638209
1700638210
[8] Sanz-Guajardo D. Plasmapheresis in the treatment of glomerulonephritis: indication and complications. Am J Kidney Dis, 2000, 36(2)
:LIV-VI.
1700638211
1700638212
[9] Siami GA, Siami FS. Plasmapheresis and paraproteinemia: cryoprotein-induced diseases, monoclonal gammopathy, Waldenstrom’s macroglobulinemia, hyperviscosity syndrome, multiple myeloma, light chain disease, and amyloidosis. Ther Apher, 1999, 3(1)
:8-19.
1700638213
1700638214
(陈江华 黄洪锋)
1700638215
1700638216
1700638217
1700638218
[
上一页 ]
[ :1.700638169e+09 ]
[
下一页 ]