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題名 | 連續雙重過濾血漿分離療法之清除率研究=Clearance Study of Serial Double-Filtration Plasmapheresis |
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作者 | 葉建宏; 邱浩彰; 白其卉; Yeh, Jiann-Horng; Chiu, Hou-Chang; Bai, Chyi-Huey; |
期刊 | 臺灣醫學 |
出版日期 | 20070900 |
卷期 | 11:5 2007.09[民96.09] |
頁次 | 頁470-475 |
分類號 | 418.88 |
語文 | chi |
關鍵詞 | 雙重過濾血漿分離術; 血漿交換; 清除率; Double-filtration plasmapheresis; Plasma exchange; Clearance; |
中文摘要 | 連續血漿分離術治療之療程選擇,文獻中極少有控制性研究。本研究收集新光醫院以雙重過濾血漿分離術方式治療一個療程,共計194例。病人接受連續3到5次血漿分離術,兩次中間間隔又分為每天及隔天進行。因此根據不同總次數及時間間隔,計可分成6組不同療程:每天1次且連續3次(3 daily sessions,簡稱D3),隔天1次且連續3次(3 alternately daily sessions,簡稱A3),每天1次且連續4次(D4),隔天1次且連續4次(A4),每天1次且連續5次(D5),隔天1次且連續5次(A5)。在每個療程前及療程後,皆抽血檢驗白球白、球蛋白、免疫球蛋白(Ig)G、IgA及IgM;並比較不同療程間的物質清除率。6組之蛋白質清除率以A3組最低,D3組,A4組,A5組,D4組,D5組依次漸增。以清除率最低的A3組做共同對照組,再以Bonferroni t test檢驗各種蛋白質在6組中最大顯著差異時,白蛋白部份,A3組與A5組的變化斜率最大(清除率自13%提昇至20%)。IgG與IgA的清除率變化趨勢與白蛋白相同,也是在A5組有最大的變動值。IgM部分,D4組的清除率為89%與A3組的70%有最大改變。大部分免疫疾病以IgG為致病因子,A3組才約4成IgG清除率,如果多加兩次變A5組可增加至54%,如果改用密集的D4組更可提升至61%。相對地白蛋白流失也將由A3組的13%拉高至A5組20%及D4組24%。因此,IgG疾病應以A5組或D4組為較佳血漿分離療程選擇。以IgM為主的免疫疾病為治療對象時,A3組已有7成的IgM清除率,增加次數如係隔天增加則助益不大,如果連續每天密集連洗4次則才有提高清除率效果至87%。不過此時白蛋白流失也會自A3組的13%提升至幾乎2倍的24%,因此,以治療IgM為主的血漿分離術,A3組應是較理想的血漿分離療程。 |
英文摘要 | There have been few controlled studies, which compared the efficacy among different plasmapheresis protocols. In this study, we evaluated the laboratory parameters of 194 consecutive patients treated with one course of double-filtration plasmapheresis (DFP) following a standard protocol except for the total numbers of sessions (3 to 5 sessions) and intervals between sessions (daily or alternately daily). A total of 6 DFP protocols listed as 3 daily sessions (D3), 3 alternately daily sessions (A3), 4 daily sessions (D4), 4 alternately daily sessions (A4), 5 daily sessions (D5), and 5 alternately daily sessions (A5). We measured the serum levels of albumin, globulin, immunoglobulin (Ig) G, IgA, and IgM before and after entire course of the DFP treatment and compared the clearance of serum proteins among these 6 different protocols. In general, the A3 protocol had the lowest mean clearance and the clearance was increasing on the order of D3, A4, A5, D4, and D5 protocols. Using the clearance of the A3 protocol as the reference group, we found significantly highest positive slopes for albumin between the A3 (13%) and A5 (20%) protocols by Bonferroni t test. IgG and IgA followed the same trend as that of albumin; while the slopes were highest in the A5 protocol. The difference of mean clearance of IgM was most significant between the A3 (70%) and D4 (89%) protocols. For treating the autoimmune diseases mostly caused by IgG autoantibody, the A3 protocol cleared only 40% of serum IgG and was less satisfactory. The A5 protocol provided 54% clearance and D4 could clear more by 7% of IgG. However, the albumin loss would become progressively severe from the A3 (13%) to A5 (20%) or D4 protocol (24%). Therefore, the A5 or D4 protocol seems to be an optimal DFP protocol for IgG-mediated diseases. In contrast, the IgM had the effective clearance by the A3 protocol (70%) and the clearance rates increased modestly despite the session of treatment increased. The D4 protocol could remove 87% of serum IgM and also 24% of serum albumin, which was almost the 2-fold loss of albumin as compared to that of the A3 protocol. Consequently, for IgM-related diseases, the A3 protocol is a better choice for DFP treatment. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。