Therapeutic effect analysis of plasma exchange therapy on rhabdomyolysis syndrome patients caused by wasp stings / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the efficacy of plasma exchange therapy in the treatment of rhabdomyolysis syndrome (RMS) caused by wasp stings. Methods Sixty patients with RMS caused by wasp stings were enrolled in the Poisoning Treatment Ward of the Affiliated Hospital of Southwest Medical University from January 2015 to June 2019, including 40 patients complicated with acute kidney injury (AKI). After admission, the patients were given local treatment and systemic medication (intravenous infusion of glucocorticoid, calcium gluconate injection, intramuscular injection of isopropazine hydrochloride and other antihistamines). Plasma exchange was performed on the first and second day after admission, and according to the renal function situations, the patients with AKI underwent intermittent hemodialysis. The changes of urea (Ur), creatinine (Cr), hypersensitive troponin T (hs-TnT), myoglobin (MYO), creatine kinase isoenzyme (CK-MB), lactic dehydrogenase (LDH) and pathological changes of kidney were monitored on admission and after twice of plasma exchanges, and the above results of indexes were compared and analyzed. Results With the prolongation of the plasma exchange time, after the first plasma exchange the level of hs-TnT was significantly higher than that before the plasma exchange [μg/L 1.30 (0.16, 4.37) vs. 0.26 (0.06, 1.26)], and the levels of LDH and CK-MB were lower than those before the exchange [LDH (μmol·s-1·L-1) 14.01 (6.73, 31.52) vs. 20.55 (8.73, 42.46), CK-MB (U/L) 41.25 (21.27, 102.83) vs. 89.92 (35.85, 163.53), both P < 0.05]; after the second plasma exchange, the Ur, Cr, LDH, hs-TnT, MYO and CK-MB were decreased significantly compared with those before the exchange [Ur (mmol/L) 9.77 (6.43, 11.90) vs. 11.58 (7.65, 19.49), Cr (μmol/L) 90.35 (67.10, 336.10) vs. 115.25 (77.50, 288.83), LDH (μmol·s-1·L-1) 7.84 (5.14, 18.68) vs 20.55 (8.73, 42.46), hs-TnT (μg/L) 0.02 (0.01, 0.09) vs. 0.26 (0.06, 1.26), MYO (μg/L) 200.00 (70.39, 1 000.00) vs. >1 000.00 (1 000.00, >1 000.00), CK-MB (U/L) 4.34 (1.86, 23.65) vs. 89.92 (35.85, 163.56), all P < 0.05]. Under light microscope, renal tubular epithelial cells fell off and showed"naked membrane", and infiltration of a small amount of inflammatory cells could be seen. Conclusion Plasma exchange can effectively remove macromolecules such as MYO, hs-TnT, CK-MB and LDH, reduce acute renal damage caused by rhabdomyolysis syndrome, shorten the course of disease and decrease mortality.