摘要
目的 对比研究双重滤过血浆置换(DFPP)和离心式治疗性血浆置换(cTPE)以及离心-膜滤过式血浆置换(CFPP)3 种不同的血浆置换(TPE)方式在改善肾移植后肾功能不全方面的疗效,以及在引发置换相关副反应方面的差异.方法 回顾性收集本院肾移植术后行TPE的46 例患者的临床资料,依据TPE方法的不同分为DFPP组(33 例)、cTPE组(7 例)、CFPP组(6 例),对比分析 3 组TPE前后患者外周血肌酐、白蛋白、血红蛋白、血小板、纤维蛋白原水平及尿量的变化.结果 DFPP 组、cTPE 组、CFPP 组 TPE 前后肌酐下降率分别是(31.40±25.38)%、(58.91±19.75)%、(39.44±28.64)%,cTPE组高于DFPP 组(P＜0.05),cTPE组与CFPP 组比较无差异(P＞0.05).DFPP组、cTPE组、CFPP组TPE前后尿量增加率分别是(49.33±30.03)%、(54.62±39.32)%、(68.89±23.00)%,3 组间两两比较无差异(P＞0.05).DFPP组、cTPE组、CFPP组血TPE后血红蛋白降低率分别是(11.97±5.94)%、(20.17±5.75)%、(9.65±8.75)%,cTPE组高于DFPP 组和CFPP 组(P＜0.05),DFPP 组与CFPP 组比较无差异(P＞0.05).DFPP组、cTPE组、CFPP组TPE前后血小板数降低率分别是(37.88±18.39)%、(24.56±12.36)%、(21.40±12.51)%,3 组间两两比较无差异(P＞0.05).DFPP组、cTPE组、CFPP组TPE前后纤维蛋白原降低率分别是(0.57±0.20)%、(0.14±0.06)%、(0.26±0.22)%,DFPP 组高于 cTPE 组(P＜0.05),DFPP 组、cTPE 组与 CFPP 组比较无差异(P＞0.05).DFPP组、cTPE组、CFPP 组 TPE 前后白蛋白降低率分别是(11.41±5.97)%,(14.67±6.52)%、(25.18±5.10)%,cTPE组、DFPP组低于CFPP组(P＜0.05),DFPP组与cTPE组比较无差异(P＞0.05).结论 3 种TPE方式对肾移植后患者肾功能、贫血、凝血功能等方面的影响存在一定差异,在选择TPE方法时,应根据患者的具体病情特点和治疗需求,并结合实验室自身技术条件及血浆供应情况综合考虑.
Abstract
Objective To compare the efficacy of double filtration plasmapheresis(DFPP),centrifugal therapeutic plasma exchange(cTPE)and centrifugation-filtration plasmapheresis(CFPP)in improving renal insufficiency after kidney transplantation,as well as the differences in inducing plasma exchange-related adverse reactions.Methods Clinical data from 46 patients who underwent plasma exchange after renal transplantation in our hospital were retrospectively collected,and patiens were divided into DFPP group(n=33),cTPE group(n=7)and CFPP group(n=6).Changes in peripheral blood creatinine,albumin,hemoglobin,platelets,fibrinogen levels and urine volume before and after TPE were compared and analyzed among the three groups.Results Among the DFPP group,cTPE group and CFPP group,the creatinine after TPE decreased by(31.40±25.38)%,(58.91±19.75)%and(39.44±28.64)%,respectively,with cTPE group significant-ly higher than the DFPP group(P＜0.05),but no significant differences between the DFPP group and cTPE group(P＞0.05);the urine volume after TPE increased by(49.33±30.03)%,(54.62±39.32)%and(68.89±23.00)%,showing no significant differences(P＞0.05);the hemoglobin after TPE decreased by(11.97±5.94)%,(20.17±5.75)%and(9.65±8.75)%,respectively,with the cTPE group significantly higher than the DFPP group and CFPP group(P＜0.05),but no significant difference between the DFPP group and CFPP group(P＞0.05).The platelet count after TPE decreased by(37.88±18.39)%,(24.56±12.36)%and(21.40±12.51)%,respectively,with no significant differences between the three groups(P＞0.05);the fibrinogen after TPE decreased by(0.57±0.20)%,(0.14±0.06)%and(0.26±0.22)%,re-spectively,with the DFPP group significantly higher than the cTPE group(P＜0.05),but the CFPP group had no significant difference with cTPE group or DFPP group(P＞0.05);the albumin after TPE decreased by(11.41±5.97)%,(14.67±6.52)%and(25.18±5.10)%,respectively,with cTPE group and DFPP group significantly lower than the CFPP group(P＜0.05,P＜0.001),but with no significant difference between the DFPP group and cTPE group(P＞0.05).Conclusion The effect of three plasma exchange methods varies on renal function,anemia and coagulation function of patients after kid-ney transplantation.It is necessary to consider the the patient's disease characteristics and treatment needs,as well as the laboratory′s technical conditions and plasma supply when selecting TPE methods.
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