Investigation on clinical application of plasma exchange in patients with abnormally increased myoglobin

Abstract

Objective To explore the effects and influential factors of plasma exchange (PE) in patients with abnormally increased myoglobin (Mb). Methods From March 2014 to December 2016, a total of 57 patients with abnormally increased Mb who underwent PE treatment at the First Hospital Affiliated to Army Medical University were selected as subjects. There were 44 male patients and 13 females; and the age of them was (50.1 ± 14.7) years old. A retrospective study was performed to collect blood routine examination and coagulation function indicators before PE treatment and after the last PE treatment, as well as serum Mb and serum creatinine (Scr) values after each PE treatment, respectively. Among them, blood routine examination indicators included white blood cell count (WBC), hemoglobin (Hb) value, platelet count and hematocrit(HCT); coagulation function indicators included activated partial thromboplastin time (APTT) and prothrombin time (PT). Paired t-test or Wilcoxon signed rank test was used to compare indicators of blood routine examination and coagulation function before and after PE treatment. Kaplan-Meier survival analysis was used to univariately analyze the factors (gender, age, disease inducement, serum Mb and Scr values before treatment) affecting the effective recovery rates of serum Mb and Scr values. This study met the requirements of the Helsinki Declaration of the World Medical Association revised in 2013. Results ① In this study, the WBC, Hb value, HCT and APPT of these 57 patients with abnormally increased Mb after PE treatment were lower than those before PE treatment, and the differences were statistically significant (t=2.291, P=0.026; t=5.033, P<0.001; t=5.079, P<0.001; Z=2.111, P=0.035). Platelet count and PT of patients decreased after treatment, but the differences were not statistically significant (Z=0.133, P=0.894; Z=1.624, P=0.104). ② In this study, there were 41 patients whose serum Mb values decreased to <1 000 μg/L after PE treatment, and the effective recovery rate of serum Mb value was 71.9% (41/57). Results of univariate analysis showed that the serum Mb and Scr values before PE treatment were the influencing factors of the effective recovery rates of serum Mb value after PE treatment (P=0.031, 0.037); and the disease inducement, serum Mb and Scr values before PE treatment were the influencing factors of effective recovery rates of Scr value after PE treatment (P=0.036, <0.001, =0.003). Conclusions PE treatment could effectively eliminate serum Mb value in patients with abnormally increased Mb and prevent renal damage. The PE treatment should be implemented as early as possible, which is able to protect renal against extended impairment at the largest extent. Key words: Plasma exchange; Myoglobin; Acute kidney injury; Creatinine; Blood purification