血浆置换联合血液透析治疗儿童狼疮性肾炎的有效性与安全性研究

doi:10.3969/j.issn.1671-2587.2026.01.009

临床输血与检验 ›› 2026, Vol. 28 ›› Issue (1): 59-64.DOI: 10.3969/j.issn.1671-2587.2026.01.009

血浆置换联合血液透析治疗儿童狼疮性肾炎的有效性与安全性研究

王笑欢, 张慧敏, 宋珊珊, 甄自达, 刘倩, 马曙轩

国家儿童医学中心，首都医科大学附属北京儿童医院，北京 100045

收稿日期:2025-03-03 发布日期:2026-02-13
通讯作者: 马曙轩，主要从事儿童输血与免疫研究，（E-mail）masxfwyy@sina.com。
作者简介:王笑欢，主要从事儿童输血与凝血等研究，（E-mai）1huanxiao1217@163.com。

Efficacy and Safety of Plasma Exchange Combined with Hemodialysis in the Treatment of Lupus Nephritis in Children

WANG Xiaohuan, ZHANG Huimin, SONG Shanshan, ZHEN Zida, LIU Qian, MA Shuxuan

Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045

Received:2025-03-03 Published:2026-02-13

摘要/Abstract

摘要： 目的探讨血浆置换（plasma exchange, PE）联合血液透析（hemodiafiltration, HDF）对儿童狼疮性肾炎（lupus nephritis, LN）的临床疗效。方法我们搜集了2022年1月1日—2024年8月31日收治在本院风湿免疫科室并做血浆置换的12名LN患儿进行回顾性分析。根据患儿的病情、性别、身高、体重、红细胞压积等指标制定治疗方案。检测患儿PE前后抗核抗体（ANA）、抗dsDNA抗体、血红蛋白（Hb）、白细胞（WBC）、血小板（PLT）、总蛋白（TP）、白蛋白（ALB）、球蛋白（GLB）、白球比（A/G）和凝血功能水平;检测出院时肌酐和尿素氮水平及置换期间肌酐的变化趋势。结果 12名患儿平均血浆置换次数约为3次，平均每次置换液总量约为1 600（1 200~2 200）mL，大约为1.3±0.23倍总血浆容量（total plasma volume, TPV），PE前后Hb、PLT、PT、PTA、INR、ALB、Cr、BUN无统计学差异（P>0.05），ANA和抗dsDNA抗体、WBC、APTT、FIB、TP、GLB、A/G具有统计学意义（P<0.05）。出院时患儿肌酐均降至100 μmol/L左右，尿蛋白阳性强度也显著减弱。结论 PE联合HDF，可有效改善狼疮性肾炎患儿的肾功能水平。

关键词: 儿童, 血浆置换, 血液透析, 系统性红斑狼疮性肾炎

Abstract: Objective To investigate the clinical efficacy of plasma exchange (PE) and hemodialysis (HD) in children with lupus nephritis. Methods We retrospectively analyzed 12 children with lupus nephritis who were admitted to the Department of Rheumatology and Immunology of our hospital for plasmapheresis from January 1, 2022 to August 31, 2024. The treatment is formulated according to the children's condition, gender, height, weight, hematocrit and other indicators. The levels of ANA, Anti-dsDNA antibody, hemoglobin, white blood cells, platelets, total protein, albumin, globulin, white globulin ratio and coagulation function were measured before and after PE. The changes in creatinine and urea nitrogen levels at discharge and during replacement were detected. Results The average number of plasma exchanges in 12 children was about 3, and the average total amount of replacement fluid was about 1 600 (1 200~2 200) mL, which was about 1.3±0.23 total plasma volume (TPV), and there were no statistically significant differences in Hb, PLT, PT, PTA, INR, ALB, Cr, and BUN before and after PE (P>0.05), WBC, APTT, FIB, TP, GLB, A/G ware statistically significant (P<0.05). At discharge, the creatinine of the children decreased to about 100 μmol/L, and the positive intensity of urine protein was also weakened. Conclusion PE combined with HDF can effectively improve renal function in children with lupus nephritis.

Key words: Child, Plasma exchange, Hemodiafiltration, Systemic lupus erythematosus nephritis

中图分类号:

R593.24R459.5

王笑欢, 张慧敏, 宋珊珊, 甄自达, 刘倩, 马曙轩. 血浆置换联合血液透析治疗儿童狼疮性肾炎的有效性与安全性研究[J]. 临床输血与检验, 2026, 28(1): 59-64.

WANG Xiaohuan, ZHANG Huimin, SONG Shanshan, ZHEN Zida, LIU Qian, MA Shuxuan. Efficacy and Safety of Plasma Exchange Combined with Hemodialysis in the Treatment of Lupus Nephritis in Children[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2026, 28(1): 59-64.

参考文献

[1] 庄远,于洋. 输血(医学)科基于离心分离技术建立单采/血液净化治疗体系的探索[J]. 临床输血与检验,2024, 26(6):721-725.
[2] 刘奇,张彬. 血浆置换在自身免疫性疾病肾脏损伤中的治疗作用[J]. 临床输血与检验,2022,24(2):264-268.
[3] HAHN B H,MCMAHON M A,WILKINSON A,et al.American College of Rheumatology guidelines for screening, treatment,and management of lupus nephritis[J]. Arthritis Care Res,2012,64(6):797-808.
[4] STUMMVOLL G H,SCHMALDIENST S, SMOLEN J S,et al.Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity[J]. Nephrol Dial Transplant,2012,27(2):618-626.
[5] ARINGER M,COSTENBADER K,DAIKH D,et al.2019 European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus[J]. Arthritis Rheumatol,2019, 71(9):1400-1412.
[6] 中华医学会儿科学分会肾脏病学组.儿童常见肾脏疾病诊治循证指南(试行)(六):狼疮性肾炎诊断治疗指南[J].中华儿科杂志,2010,48(9):687-690.
[7] LISNEVSKAIA L,MURPHY G,ISENBERG D.Systemic lupus erythematosus[J]. Lancet,2014,384(9957): 1878-1888.
[8] SILVA C A,AVCIN T,BRUNNER H I.Taxonomy for systemic lupus erythematosus with onset before adulthood[J]. Arthritis Care Res,2012,64(12):1787-1793.
[9] SMITH E M D,LYTHGOE H,MIDGLEY A,et al. Juvenile-onset systemic lupus erythematosus: Update on clinical presentation,pathophysiology and treatment options[J]. Clin Immunol,2019,209:108274.
[10] AGGARWAL A,SRIVASTAVA P.Childhood onset systemic lupus erythematosus: how is it different from adult SLE?[J]. Int J Rheum Dis,2015,18(2):182-191.
[11] TAHER A,BADREDDINE R,DEEB J,et al.Close relationship between systemic lupus erythematosus and thrombotic thrombocytopenic Purpura in childhood: comment on the article by Brunner et al[J]. Arthritis Rheum, 2002,46(5):1410.
[12] SMITH E M D,YIN P,JORGENSEN A L,et al. Clinical predictors of active LN development in children-evidence from the UK JSLE Cohort Study[J]. Lupus, 2018, 27(13): 2020-2028.
[13] RAHMAN P,GLADMAN D D,IBANEZ D,et al.Significance of isolated hematuria and isolated pyuria in systemic lupus erythematosus[J]. Lupus, 2001,10(6): 418-423.
[14] 朱鑫方,俞海,钟繇,等. 输血科在神经系统疾病实施治疗性血浆置换的应用流程[J]. 中国输血杂志,2021,34(11): 1275-1277.
[15] 韦雪芸. 血浆置换不良反应发生情况及影响因素分析[J]. 当代护士(下旬刊),2021,28(7):31-34.
[16] 王鹏展. 血浆置换方法治疗神经系统疾病的安全性探讨[J]. 中国医学工程,2021,29(7):101-103.
[17] JOUVE T,MARLU R,NACIRI BENNANI H,et al.Fibrinogen reconstitution after therapeutic apheresis: Comparison of double-filtration plasmapheresis, plasma exchange, and immunoadsorption[J]. J Clin Apher,2021, 36(4):574-583.

血浆置换联合血液透析治疗儿童狼疮性肾炎的有效性与安全性研究

Efficacy and Safety of Plasma Exchange Combined with Hemodialysis in the Treatment of Lupus Nephritis in Children

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

关于本刊

作者中心

在线期刊

访问统计

联系我们

[1]	张媛媛, 王慧茹, 应美爱, 潘健, 刘磊, 刘会兰. 血浆置换联合抗B细胞治疗药物应用于造血干细胞移植DSA阳性患者中的效果观察^*[J]. 临床输血与检验, 2025, 27(2): 156-162.
[2]	王刚, 高旖鑫, 吴林燕, 杨明会, 何苏英, 彭永正. 半全血置换治疗低体重儿童自身免疫性溶血性贫血并发溶血危象1例[J]. 临床输血与检验, 2025, 27(2): 196-199.
[3]	庄远, 于洋. 输血（医学）科基于离心分离技术建立单采/血液净化治疗体系的探索[J]. 临床输血与检验, 2024, 26(6): 721-725.
[4]	杨昊, 董树岭, 杨乾坤, 韩月, 王书亚, 靳慧芳, 郑露, 唐悦. 双重滤过血浆置换和血浆置换对ABO血型不容肾移植受者术前血型抗体去除效果单中心对比研究^*[J]. 临床输血与检验, 2024, 26(3): 325-331.
[5]	李佩华, 苏焕正, 沙夏珺, 罗文英. 慢加急性肝衰竭血浆置换治疗期间死亡的危险因素探讨：基于PSM法[J]. 临床输血与检验, 2024, 26(3): 345-352.
[6]	钟馨, 邱浩川, 陈斯亮, 李朝晖, 毛怀东, 章俊. 低血红蛋白密度对血液透析贫血患者缺铁性贫血和铁缺乏的诊断价值分析^*[J]. 临床输血与检验, 2023, 25(5): 654-661.
[7]	付晓艳, 甄自达, 邱立娟, 张慧敏, 王孟键, 马曙轩. 红细胞储存时间与体外循环心脏手术患儿术后急性肾损伤的关系[J]. 临床输血与检验, 2023, 25(4): 489-493.
[8]	孙秋爽, 梁卉. 行异基因造血干细胞移植治疗的伴严重血小板减少的儿童MYH9相关疾病1例并文献复习[J]. 临床输血与检验, 2023, 25(4): 544-548.
[9]	徐丽娟, 秦京京, 谭亦超, 骆群. 血浆置换联合血液灌流救治重度汞中毒1例[J]. 临床输血与检验, 2023, 25(4): 552-554.
[10]	刘琴, 沈先涛, 徐春芬, 王阳, 杨柳春, 胡红兵. 自体富血小板血浆治疗儿童病理性骨折疗效观察^*[J]. 临床输血与检验, 2023, 25(3): 354-357.
[11]	温普生, 杨媛淇, 彭雪松, 何柏霖, 邓玉华. 140例儿童活体肝移植术中大量输血的高危因素分析^*[J]. 临床输血与检验, 2023, 25(1): 97-102.
[12]	陈蕊, 吕孟兴, 尹加忠, 沈经纬, 熊荣, 白云艳, 周文彪, 王旭, 杨琦, 屈柯暄. 云南省地中海贫血儿童输血安全策略的研究^*[J]. 临床输血与检验, 2022, 24(6): 710-715.
[13]	钟杰, 茹雪, 王安凤. 血清IL-6、FGF-23水平与慢性肾衰竭血透患者蛋白质-能量消耗发生的关系[J]. 临床输血与检验, 2022, 24(6): 777-784.
[14]	陈娟娟, 孙岩, 何丽莉, 王宇静, 周小艳, 钟育祥, 李兆. 不同浓度枸橼酸钠分段式抗凝方案在血液透析患者中的抗凝效果对比^*[J]. 临床输血与检验, 2022, 24(4): 469-476.
[15]	李津杞, 臧艳, 李津婴, 查占山, 钱宝华. 输血治疗儿童遗传性难治性溶血性贫血的回顾性分析[J]. 临床输血与检验, 2022, 24(3): 325-327.