目的 评估离心式血细胞分离机实施治疗性血浆置换(therapeutic plasma exchange，TPE)时/后对神经系统免疫介导疾病患者血小板计数的影响。方法 本研究纳入了2021年3月到2022年3月期间在复旦大学附属华山医院神经内科住院治疗的189例患者(108例女性，81例男性)，共进行820次TPE治疗。每例患者接受2～5次血浆置换，每次置换量为患者1倍血浆容量。对TPE前和TPE治疗2～5次后患者的外周血细胞计数进行评估。结果 单次TPE时长为94(84，107)min，单次TPE实际置换量为2456(2142，2785)mL。TPE治疗2、3、4、5次的患者例数分别是17、28、18和126。TPE前后患者PLT计数分别是195(150，245)×109/L vs 220(170，270)×109/L(P<0。05)。故TPE后PLT计数总体较基线显著下降，然而TPE后血小板计数仍在正常范围内。Spearman相关性分析显示血小板损失与TPE时长(ρ=0。037)、患者年龄(ρ=0。015)、单次置换液容量(ρ=0。034)无相关性(P均>0。05)，与TPE次数(ρ=0。017)弱相关，与TPE前血小板计数(ρ=0。446)中等相关。结论 TPE对患者血小板有一定的影响，但TPE后患者血小板计数仍在正常范围，不会影响患者后续的治疗。TPE后血小板下降水平与治疗前基础血小板水平和TPE治疗次数之间存在相关性。
Impact of centrifugal therapeutic plasma exchange on platelet counts in patients with neurological autoimmune diseases
Objective To assess the effect of a centrifugal haemocyte separator on platelet counts in patients with neu-rological immune-mediated disorders during/after therapeutic plasma exchange (TPE). Methods This study included 189 patients (108 females and 81 males) who were treated in the department of neurology at Huashan Hospital,Fudan Universi-ty,from March 2021 to March 2022. A total of 820 TPE treatments were carried out. Each patient received 2 to 5 TPEs,with each TPE amounting to the patient's plasma volume. The peripheral blood cell counts of the patients were evaluated be-fore TPE and after 2 to 5 TPEs. Results The duration of a single TPE in this study was 94(84,107) minutes,and the ac-tual volume of a single TPE replacement was 2456(2142,2785) mL. The number of patients who underwent TPE for 2,3,4,and 5 sessions was 17,28,18,and 126,respectively. The platelet (PLT) counts of the patients before and after the TPE were 195×109/L (range:150 to 245) and 220×109/L (range:170 to 270),respectively (P<0.05). Consequently,the overall PLT counts exhibited a significant decrease from baseline following TPE,yet the PLT counts remained within the normal range after TPE. Spearman's correlation analysis indicated that platelet loss did not correlate with the duration of TPE (ρ=0.037),the age of the patient (ρ=0.015),or the volume of the single replacement fluid (ρ=0.034),P>0.05,weakly correlated with the number of TPE sessions (ρ=0.017),and moderately correlated with the PLT counts before TPEs (ρ=0.446). Conclusion The TPE procedure exhibited a measurable impact on the patients' platelet levels,but the platelet counts remained within the normal range,therefore did not interfere with the patients' subsequent treatment proto-cols.The decrease in platelet level was correlated with the baseline platelet level before treatment and the number of TPE sessions.
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