Efffect Of Plasma Exchange Combined With Continuous Blood Purification On Pediatric Hemophagocytic Syndrome

Objective:To investigate the clinical efficacy of plasma exchange(PE)combined with Continuous blood purification(CBP)in the treatment of hemophagocytic syndrome with severe organ damage with conventional chemotherapy.Methods:The data of children with Hemophagocytic lymphohistiocytosis(HLH)diagnosed and treated in Children's Hospital of Hunan Province from January 2015 to January 2018 were collected and divided into a control group and a blood purification group according to different treatment methods.And a retrospective study was conducted to analyze the changes of diagnostic index,inflammatory index,coagulation index,liver function index,renal function index,and myocardial enzymes index in the two groups at the time of diagnosis and 7th day of treatment,a statistical analysis was also performed at the same time.Result:1.The data of 61 children with HLH were collected,including 30 patients in the blood purification group,16 males and 14 females,aged from 6months to 9 years and 9 months;31 patients in the control group,19 males and 12 females;aged 2 months to 12 years and 9 months.2.In diagnostic index Triglyceride(TG),Total Cholesterol(CHOL),Fibrinogen(FIB),Serum Ferritin(SF),Neutrophil(ANC),Hemoglobin(Hb),Platelet(Plt),inflammatory index C reactive protein(CRP),Procalcitonin(PCT),coagulation function index Prothrombin time(PT),Activated partial thromboplastin time(APTT),International normalized ratio(INR),liver function index Total bilirubin(TBIL),Alanine aminotransferase(ALT),aminotransferase(AST),Total bile acid(TBA),renal function index Blood urea nitrogen(BUN),Serum creatinine(Scr)and myocardial enzyme index Creatine Kinase(CK),Creatine kinase isoenzymes(CK-MB),Lactate dehydrogenase(LDH),there was no statistically significant difference in the time of diagnosis between the two groups(P > 0.05).3.After 7 days of treatment,the diagnostic index CHOL,liver function index TBA and renal function index BUN,in the control group were statistically significant difference compared with those before treatment(P < 0.05),while in the diagnostic index TG,FIB,SF,inflammatory index CRP,PCT,coagulation function index PT,APTT,INR,liver function index TBIL,ALT,AST,renal function index Scr,myocardial enzyme index CK,CK-MB and LDH,there was no statistically significant difference before treatment(P > 0.05).4.After 7 days of treatment,the diagnostic index CHOL,inflammatory index CRP,PCT,coagulation function index PT,APTT,INR,liver function index ALT,AST,TBA,renal function index Scr,myocardial enzyme indicators CK-MB,LDH in the blood purification group were statistically significant difference before treatment(P <0.05),while in diagnostic index TG,FIB,SF,ANC,Hb,Plt,liver function index TBIL,renal function index BUN and myocardial enzyme index CK,there was no statistically significant difference before treatment(P > 0.05).5.After 7 days of treatment,the rate of heat withdrawal in the blood purification group was higher than that in the control group(P <0.05).In the blood purification group,the decrease in diagnosis index TG,inflammatory index CRP,PCT,liver function index ALT,AST,and renal function index BUN,Scr,and enzyme index LDH was higher than that in the control group(P < 0.05).While in diagnostic index TG,FIB,SF,ANC,Hb,Plt and coagulation function index PT,APTT,INR,liver function index TBIL,TBA,and myocardial enzyme index CK,CK-MB,there was no statistically significant difference between the two groups(P > 0.05).6.The blood purification group had 11 cases of edema,5 cases of severe bleeding,1 case of arrhythmia,1 case of hypotension,and 1 case of tubal blockage.7.After 7 days of treatment,28 cases survived in the blood purification group,and 19 cases survived in the control group;After 2 months of treatment,22 cases survived in the blood purification group and 11 cases survived in the control group.The survival rate of patients at 7th days of treatment and 2 months after treatment in the blood purification group was higher than control group(P < 0.05).Conclusion:PE combined with CBP and conventional chemotherapy in the treatment of HLH can quickly control body temperature and improve symptoms of hyperlipidemia in children.It can also reduce the degree of systemic inflammatory response,improve coagulation,liver function and renal function in children,and improve survival rate.The curative effect is superior to conventional Chemotherapy is an effective adjuvant therapy for children with HLH who have organ failure.