淋巴血浆置换治疗吉兰-巴雷综合征的临床疗效及其机制

目的观察淋巴血浆置换(lymphoplasmapheresis,LPE)治疗吉兰-巴雷综合征(Guillain-Barre syndrome,GBS)的临床疗效并探讨其治疗机制。方法 30例GBS患者进行淋巴血浆置换治疗,观察治疗前后神经功能改善状况,并检测治疗前后血液中免疫全套、血常规、凝血四项及淋巴细胞亚群的变化。结果淋巴血浆置换治疗1w后患者MRC评分、2w后MRC评分及Hughes评分均较治疗前有显著改善,2w后有效率高达90%。患者外周血免疫球白及补体、单核细胞百分比、纤维蛋白原等指标于治疗后显著降低。治疗后淋巴细胞亚群中CD8+T细胞百分率显著升高,CD4+/CD8+值显著降低,并且2w后Hughes评分提高大于1分者这种变化更为显著,而2w后Hughes评分提高小于1分者淋巴细胞亚群分布较治疗前无明显变化。结论 LPE治疗GBS疗效显著,可能与纠正GBS患者外周血淋巴细胞亚群紊乱,直接去除免疫球蛋白及补体、单核细胞、纤维蛋白原等病理性物质有关。

Therapeutic effect of lymphoplasmapheresis in treatment of Guillain-Barre syndrome and its mechanism

Objective To observe the therapeutic effect of lymphoplasmapheresis(LPE)in treatment of Guillain-Barre syndrome(GBS)and to explore its mechanism.Methods The change of neurological functions,and the difference of the complete immunity,blood routine,conventional blood coagulation and lymphocyte subsets in peripheral blood before and after treatment with LPE were observed in 30 GBS patients.Results After the treatment of LPE,the MRC scores on one and two weeks was prominently improved as well as the Hughes scores,and the effective rate reached 90%.The level of immunoglobulin,complement,the percentage of mononuclear cells and fibrinogen in blood was notably decreased after the treatment.After therapy,the percentage of CD8+ T lymphocyte was significantly increased and the ratio of CD4+/CD8+ lymphocyte subset was decreased,especially when the increase of Hughes scores was more than 1 in contrast to the opposite condition with little variation.Conclusion There was a significant effect in that LPE was used to treat GBS,which probably by correcting the disorder of peripheral blood lymphocyte subsets,and the direct removal of immunoglobulin,complement,mononuclear cells,fibrinogen and other pathological substances.