雙重過濾血漿析離療法之血液學變化－－每日及隔日療法之比較

Hematological Changes in Double Filtration Plasmapheresis－Daily Versus Alternate Day Schedule

血漿析離術可以除去血漿中之物質而達到治療各類相關疾病之目的。我們以5次治療為一療程之雙重過濾血漿析離術治療了46位病人，包括35例重症肌無力，10例急性神經炎及1例急性進行性腎綠球腎炎。根據析離治療間隔分成每日療法組及隔日療法組，兩組各23人。在每個療程前及療程後，皆抽血檢驗其血中蛋白質，包括白球白、球蛋白、免疫球蛋白(Ig) G、IgA、IgM、膽固醇、低密度脂蛋白、高密度脂蛋白，及三酸甘油脂和血球計數；並比較兩組間物質清除率之差異。平均血清蛋白質清除率而言，不論是膽固醇(77% vs. 62.2%), IgA (78.9% vs. 68.8%), IgM (93.4% vs. 81.8%), IgG (67.5% vs. 57.3%)或是球蛋白(57% vs. 49%)在每日療法組皆略高於隔日療法組。至於血球計數、白蛋白、脂蛋白及三酸甘油脂部分，兩組間未見明顯差異。全部療程中除2.3%病人出現低血壓外，其餘皆相當地安全。我們研究的結果顯示以血清學上影響而言，每日療法之血漿析離術在治療免疫相關疾病上似乎是較有效的。

Plasmapheresis is effective in various disease states by its removal of plasma solutes. We treated 46 patients with immune-mediated diseases including myasthenia gravis(n=35), Guillain-Barre syndrome (n＝10), and rapid progressive glomerulonephritis (n=1),with double filtration plasmapheresis (DP)for five consecutive sessions. Patients were received either a daily or alternate day schedule, with 23 patients in each group. Serum proteins including albumim, globulin, immunoglobulin G (IgG), IgA, IgM, cholesterol, low density lipoprotein, high density lipoprotein, triglyceride, and complete blood counts were measured before and after the course of plasmapheresis in each group of patients. The mean percent reductions of serum proteins in the daily vs. alternate day schedule were as follows: cholesterol (77% vs. 62.2%), IgA (78.9% vs. 68.8%), IgM (93.4% vs. 81.8%), IgG (67.5% vs. 57.3%), and globulin (57% vs. 49%). The mean reductions were significantly higher in the daily group. There were no significant differences in blood counts, albumin, lipoproteins, and triglyceride levels agter treatment between these 2 groups. All the patients tolerated the plasmapheresis well except for 2.3% of them experienced hypotension. Our results suggest that daily plasmapheresis may be more effective in the treatment of patients with immune-mediated diseases in terms of serological changes.