PDF(Pubmed)
Abstract：
BACKGROUND: Therapeutic plasma exchange (TPE) is a highly effective rescue treatment for patients with acute exacerbation of neuroimmunological disease that removes circulating autoantibodies and inflammatory components from the bloodstream. The aims of this study are to explore the safety and the effectiveness of TPE in patients with autoimmune neurological disorders.
METHODS: We retrospectively evaluated the frequency of adverse events (AEs) and the effectiveness of TPE using the modified Ranking Scale (mRS) in patients with acute neurological flares who underwent TPE at the University Hospital of Palermo.
RESULTS: Of 59 patients, the majority underwent TPE due to multiple sclerosis (MS) relapse. In 23.7% of cases, TPE was performed before obtaining a definite diagnosis due to the severity of the clinical presentation. After TPE, the mRS score was globally reduced (p < 0.0001), and this effect was marked in patients with MS, Guillain-Barré syndrome, and myasthenia gravis crisis but not in those with paraneoplastic syndromes. Circulating pathogenetic antibodies, younger age, and the early use of TPE were factors strongly associated with TPE effectiveness. The overall safety profile of TPE was satisfactory with an AE frequency of 15%.
CONCLUSIONS: These results highlight the early use of TPE in patients with circulating pathogenetic antibodies as well as its favorable safety profile.
METHODS: We retrospectively evaluated the frequency of adverse events (AEs) and the effectiveness of TPE using the modified Ranking Scale (mRS) in patients with acute neurological flares who underwent TPE at the University Hospital of Palermo.
RESULTS: Of 59 patients, the majority underwent TPE due to multiple sclerosis (MS) relapse. In 23.7% of cases, TPE was performed before obtaining a definite diagnosis due to the severity of the clinical presentation. After TPE, the mRS score was globally reduced (p < 0.0001), and this effect was marked in patients with MS, Guillain-Barré syndrome, and myasthenia gravis crisis but not in those with paraneoplastic syndromes. Circulating pathogenetic antibodies, younger age, and the early use of TPE were factors strongly associated with TPE effectiveness. The overall safety profile of TPE was satisfactory with an AE frequency of 15%.
CONCLUSIONS: These results highlight the early use of TPE in patients with circulating pathogenetic antibodies as well as its favorable safety profile.
摘要：
背景：治疗性血浆置换（TPE）是一种用于神经免疫疾病急性加重患者的高效抢救治疗方法，可从血流中去除循环自身抗体和炎症成分。这项研究的目的是探讨TPE在自身免疫性神经系统疾病患者中的安全性和有效性。
方法：我们回顾性评估了在巴勒莫大学医院接受TPE治疗的急性神经耀斑患者的不良事件（AE）发生频率和TPE的有效性。
结果：59例患者中，大多数患者因多发性硬化(MS)复发而接受了TPE.在23.7%的案例中，由于临床表现的严重程度，在获得明确诊断之前进行TPE。TPE后,MRS评分在全球范围内降低(p<0.0001)，这种效果在MS患者中很明显，格林-巴利综合征,重症肌无力危象，但在副肿瘤综合征患者中没有。循环致病抗体，年龄较小,早期使用TPE是与TPE疗效密切相关的因素。TPE的总体安全性令人满意，AE频率为15％。
结论：这些结果强调了TPE在循环致病抗体患者中的早期使用及其良好的安全性。
方法：我们回顾性评估了在巴勒莫大学医院接受TPE治疗的急性神经耀斑患者的不良事件（AE）发生频率和TPE的有效性。
结果：59例患者中，大多数患者因多发性硬化(MS)复发而接受了TPE.在23.7%的案例中，由于临床表现的严重程度，在获得明确诊断之前进行TPE。TPE后,MRS评分在全球范围内降低(p<0.0001)，这种效果在MS患者中很明显，格林-巴利综合征,重症肌无力危象，但在副肿瘤综合征患者中没有。循环致病抗体，年龄较小,早期使用TPE是与TPE疗效密切相关的因素。TPE的总体安全性令人满意，AE频率为15％。
结论：这些结果强调了TPE在循环致病抗体患者中的早期使用及其良好的安全性。
