治疗性血交换在严重的Graves疾病与血液学和肝脏并发症
Vivek Jha1, Amal Shaharyar1, Kavyanjali Kundu1
1Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
JCEM case reports
|November 3, 2025
概括
治疗性血交换 (TPE) 提供了安全有效的桥梁疗法,用于当抗甲状腺药物禁用时,严重的格雷夫斯甲状腺毒素. 这种方法可以快速控制,促进在高风险患者中进行手术或放射性切除等最终治疗.
科学领域:
- 内分泌学 在内分泌学.
- 内部医学 内部医学
- 血液学 血液学 血液学
背景情况:
- 严重的格雷夫斯甲状腺毒性病带来危及生命的风险.
- 抗甲状腺药物可能因副作用如中性质衰竭或肝功能障碍而禁用.
- 标准的终极治疗方法 (手术,放射性) 可能不适合在危急情况下立即使用.
研究的目的:
- 评估治疗性血交换 (TPE) 的有效性和安全性,作为重症甲状腺毒素症患者的桥梁策略,并对传统疗法的禁忌.
- 证明TPE在实现快速生化控制和实现最终治疗方面的作用.
主要方法:
- 关于两名患有严重格雷夫斯甲状腺毒性病的年轻女性的病例报告.
- 抗甲状腺药物因中性质衰竭和肝功能障碍/细胞衰竭而禁用.
- 治疗性血交换 (TPE) 被用作一个临时措施.
- 患者随后接受了最终的治疗 (甲状腺切除术或放射性切除术).
主要成果:
- 一次单次TPE疗程稳定了一名患者的甲状腺切除术.
- 三次TPE疗程改善了第二名患者的病情,扭转了肝功能障碍和细胞衰退,并使放射性的切除成为可能.
- 在这两位患者中都没有观察到与TPE相关的并发症.
- 在这两种高风险病例中,TPE促进了及时过渡到最终治疗.
结论:
- 治疗性血交换是一种安全有效的临时治疗复杂的甲状腺毒素症.
- TPE允许快速生化控制,在常规疗法禁用时,将患者连接到最终治疗.
- 这种方法在高风险环境中是有价值的,用于管理严重的Graves病.
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