■适当的治疗减少了中枢神经系统(CNS)脱髓鞘疾病复发的严重程度和持续时间。如果大剂量皮质类固醇治疗失败,治疗性血浆置换(TPE)被认为是一种抢救治疗。
■本研究旨在探讨中枢神经系统脱髓鞘性复发中TPE的早期临床反应和并发症以及预后因素。
■这项前瞻性观察研究是在三级中心设计的,为期一年。
■所有诊断为皮质类固醇抵抗型多发性硬化(MS)的成年患者,视神经脊髓炎谱系障碍(NMOSD),独特型横断脊髓炎或临床孤立综合征复发,有资格。临床反应基于出院时的扩展残疾状态量表(EDSS)来定义。记录临床和实验室并发症。
■分析了72例患者,其中58.3%的患者为女性。61.1%的病例被诊断为MS。35例患者(48.6%)有反应,EDSS的平均差异显着降低了0.60分(CI95%:0.44-.77)。电解质失衡和血小板减少分别发生在80.6%和55.6%的病例中,40.3%的患者有全身反应。然而,26.4%患者出现中度至重度并发症。在中度至重度残疾的患者中,反应者更年轻(MD:8.42岁,CI95%:1.67-15.17),并且在入院时EDSS得分较低(中位数:6,IQR:5.5-6对7.5IQR:6.5-8)。与RRMS患者相比,活动性进行性MS患者的失败风险更高(OR:6.06,CI95%:1.37-26.76)。血小板减少症患者比其他人住院更多(MD:1.5天,CI95%:0-3)。女性更容易发生低钾血症和全身反应(OR:3.11,CI95%:1.17-8.24和OR:6.67,CI95%:2.14-20.81)。
■TPE最常见的适应症是皮质类固醇耐药的重度MS复发。大约一半的患者出现早期临床反应。较低的残疾,年龄小和RRMS诊断是预后较好的预后因素.四分之一的患者出现中度至重度并发症,主要是电解质失衡和全身反应。TPE期间应考虑对这些并发症采取适当的干预措施,尤其是女性。
UNASSIGNED: Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment.
UNASSIGNED: This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses.
UNASSIGNED: This prospective observational study was designed in a tertiary center during one year.
UNASSIGNED: All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded.
UNASSIGNED: Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42 years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively).
UNASSIGNED: The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.