血浆置换%紫癜,血栓性血小板减少性%疗效比较研究%安全性
血漿置換%紫癜,血栓性血小闆減少性%療效比較研究%安全性
혈장치환%자전,혈전성혈소판감소성%료효비교연구%안전성
Plasma exchange%Purpura,thrombotic thrombocytopenic%Comparative effectiveness research%Safety
目的 观察床旁血浆置换治疗血栓性血小板减少性紫癜(TTP)患者的临床疗效.方法 选择1997年1月至2014年4月,于中山大学附属第一医院收治的120例TTP住院患者作为研究对象.将其按照治疗方式分别纳入研究组(n=58,采用常规治疗与床旁血浆置换治疗)与对照组(n=62,采用常规治疗).观察床旁血浆置换的疗效及安全性.本研究遵循的程序符合中山大学附属第一医院人体试验委员会所制定的伦理学标准,得到该委员会批准.结果 研究组贫血缓解时间、溶血缓解时间及住院时间均明显短于对照组,差异有统计学意义(t=11.21,16.01,4.86;P=0.000 1,0.000 1,0.000 1).治疗前,两组患者急性生理和慢性健康状况评价(APACHEⅡ)评分相比较,差异无统计学意义(t=0.84,P=0.40);治疗后第4天,两组患者APACHEⅡ评分相对于治疗前均有所下降,且两组APACHEⅡ评分相比较,差异有统计学意义(t=6.39,P＜0.05).治疗前,两组患者血浆D-二聚体、甲状腺球蛋白(TG)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平相比较,差异均无统计学意义(t=0.71,1.22,0.61,1.00;P=0.47,0.22,0.52,0.31).治疗后第6天,两组患者血浆D-二聚体、TG、TNF-α、IL-6水平相比较,差异均有统计学意义(t=19.03,9.63,11.47,13.75;P=0.000 1,0.000 1,0.000 1,0.000 1),研究组的血浆D-二聚体、TG、TNF-α、IL-6水平均显著低于对照组.研究组在接受血浆置换治疗时,出现2例低血压、1例荨麻疹,经对症治疗后均好转.结论 床旁血浆置换可使TTP患者受益,且安全有效,值得临床推广.
目的 觀察床徬血漿置換治療血栓性血小闆減少性紫癜(TTP)患者的臨床療效.方法 選擇1997年1月至2014年4月,于中山大學附屬第一醫院收治的120例TTP住院患者作為研究對象.將其按照治療方式分彆納入研究組(n=58,採用常規治療與床徬血漿置換治療)與對照組(n=62,採用常規治療).觀察床徬血漿置換的療效及安全性.本研究遵循的程序符閤中山大學附屬第一醫院人體試驗委員會所製定的倫理學標準,得到該委員會批準.結果 研究組貧血緩解時間、溶血緩解時間及住院時間均明顯短于對照組,差異有統計學意義(t=11.21,16.01,4.86;P=0.000 1,0.000 1,0.000 1).治療前,兩組患者急性生理和慢性健康狀況評價(APACHEⅡ)評分相比較,差異無統計學意義(t=0.84,P=0.40);治療後第4天,兩組患者APACHEⅡ評分相對于治療前均有所下降,且兩組APACHEⅡ評分相比較,差異有統計學意義(t=6.39,P＜0.05).治療前,兩組患者血漿D-二聚體、甲狀腺毬蛋白(TG)、腫瘤壞死因子(TNF)-α、白細胞介素(IL)-6水平相比較,差異均無統計學意義(t=0.71,1.22,0.61,1.00;P=0.47,0.22,0.52,0.31).治療後第6天,兩組患者血漿D-二聚體、TG、TNF-α、IL-6水平相比較,差異均有統計學意義(t=19.03,9.63,11.47,13.75;P=0.000 1,0.000 1,0.000 1,0.000 1),研究組的血漿D-二聚體、TG、TNF-α、IL-6水平均顯著低于對照組.研究組在接受血漿置換治療時,齣現2例低血壓、1例蕁痳疹,經對癥治療後均好轉.結論 床徬血漿置換可使TTP患者受益,且安全有效,值得臨床推廣.
목적 관찰상방혈장치환치료혈전성혈소판감소성자전(TTP)환자적림상료효.방법 선택1997년1월지2014년4월,우중산대학부속제일의원수치적120례TTP주원환자작위연구대상.장기안조치료방식분별납입연구조(n=58,채용상규치료여상방혈장치환치료)여대조조(n=62,채용상규치료).관찰상방혈장치환적료효급안전성.본연구준순적정서부합중산대학부속제일의원인체시험위원회소제정적윤리학표준,득도해위원회비준.결과 연구조빈혈완해시간、용혈완해시간급주원시간균명현단우대조조,차이유통계학의의(t=11.21,16.01,4.86;P=0.000 1,0.000 1,0.000 1).치료전,량조환자급성생리화만성건강상황평개(APACHEⅡ)평분상비교,차이무통계학의의(t=0.84,P=0.40);치료후제4천,량조환자APACHEⅡ평분상대우치료전균유소하강,차량조APACHEⅡ평분상비교,차이유통계학의의(t=6.39,P＜0.05).치료전,량조환자혈장D-이취체、갑상선구단백(TG)、종류배사인자(TNF)-α、백세포개소(IL)-6수평상비교,차이균무통계학의의(t=0.71,1.22,0.61,1.00;P=0.47,0.22,0.52,0.31).치료후제6천,량조환자혈장D-이취체、TG、TNF-α、IL-6수평상비교,차이균유통계학의의(t=19.03,9.63,11.47,13.75;P=0.000 1,0.000 1,0.000 1,0.000 1),연구조적혈장D-이취체、TG、TNF-α、IL-6수평균현저저우대조조.연구조재접수혈장치환치료시,출현2례저혈압、1례담마진,경대증치료후균호전.결론 상방혈장치환가사TTP환자수익,차안전유효,치득림상추엄.
Objective To observe the clinical curative effect of bedside plasma exchange on treatment of patients with thrombotic thrombocytopenic purpura (TTP).Methods From January 1997 to April 2014,a total of 120 cases of TTP patients who hospitalized in First Affiliated Hospital of Sun Yet-Sen University were collected into this study.They were divided into study group (n=58,accepted conventional treatment and bedside plasma exchange treatment) and control group (n=62,accepted conventional treatment).The curative effect and security of bedside plasma exchange were evaluated.The study protocol was approved by the Ethical Review Board of Investigation in First Affiliated Hospital of Sun Yet-Sen University.Results The alleviation time of anemia,hemolysis,and hospitalization in study group were significantly lower than the control group,with statistically significant difference (t =11.21,16.01,4.86,P =0.000 1,0.000 1,0.000 1).Before treatment,there were no statistical differences of the acute physiology and chronic health evaluation (APACHE) Ⅱ scores between two groups (t=0.84,P=0.40).4 days after treatment,there was statistical difference between two groups of APACHE Ⅱ scores (t=6.39,P＜0.05) and the APACHE Ⅱ scores in both two groups decreased.Before treatment,there were no statistical differences among the levels of plasma D-dimer,thyroglobulin (TG),tumor necrosis factor (TNF)-α,interleukin (IL)-6 between two groups (t=0.71,1.22,0.61,1.00;P=0.47,0.22,0.52,0.31).But 6 days after treatment,there were statistical differences among levels of plasma D-dimer,TG,TNF-α and IL-6 between two groups.And these indicators in study group were significantly lower than those in control group.There were 2 cases of hypotension and 1 case of urticaria occurred in study group,and those in symptoms were alleviated after symptomatic treatment.Conclusions Patients with TTP can benefit from the bedside plasma exchange treatment which is safe and effective,worthy of clinical promotion.
