不同人工肝方法治疗亚急性重型肝炎的疗效对比研究

发布时间：2019-04-01 06:35

【摘要】：目的观察血浆置换(PE)、血浆置换联合血浆胆红素吸附(PE+PBA)与血浆置换联合双重血浆分子吸附系统(PE+DPMAS)治疗亚急性重型肝炎的临床疗效,探讨重型肝炎的最佳人工肝治疗方案。方法统计同期收治的应用人工肝治疗的140例乙型肝炎病毒(HBV)感染亚急性重型肝炎病例,按照PE、PE+PBA、PE+DPMAS分为3组,对比3组患者治疗前、后临床症状及血常规、电解质和主要生化指标的变化。结果 PE+DPMAS组治疗有效率70.8%,稍高于PE、PE+PBA两组(60.9%、67.4%),但差异无统计学意义(P0.05);治疗前、后3组患者血清总胆红素(TBIL)、丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、球蛋白(GLB)等生化指标较治疗前明显下降(P0.001),治疗后PE组前清蛋白(PA)较治疗前升高,PE+PBA组和PE+DPMAS组均较治疗前降低,差异有统计学意义(P0.05);PE组凝血酶原时间(PT)较治疗前下降(P0.05),PE+PBA组PT较治疗前下降,PE+DPMAS组PT较治疗前稍升高,但差异无统计学意义(P0.05);PE组血清K+、Cl-较治疗前明显降低(P0.001);PE组治疗前、后血清Na+差异无统计学意义(P0.05),PE+PBA、PE+DPMAS组血清Na+较治疗前降低(P0.001);3组血清Ca2+均较治疗前降低,差异有统计学意义(P0.001);血常规WBC、Hb、PLT治疗前、后比较差异有统计学意义(P0.05)。结论 PE单独应用和联合PBA或DPMAS,均可有效改善亚急性重型肝炎患者的肝功能,提高救治率;联合治疗可节省血浆用量2/3,方便更多患者使用;PE联合DPMAS对患者血清Cl-、Ca2+及Hb下降的影响幅度最小,具有更佳的临床应用价值。
[Abstract]:Objective to observe the clinical efficacy of plasma exchange (PE), combined with bilirubin adsorption (PE PBA) and plasma exchange combined with double plasma molecular adsorption system (PE DPMAS) in the treatment of subacute severe hepatitis. Objective: to explore the best treatment scheme of artificial liver for severe hepatitis. Methods A total of 140 patients with subacute severe hepatitis B virus (HBV) infection treated with artificial liver were divided into three groups according to PE,PE PBA,PE DPMAS. The clinical symptoms and blood routine were compared before and after treatment in three groups. Changes in electrolytes and major biochemical indicators. Results the effective rate of treatment in PE DPMAS group was 70.8%, which was slightly higher than that in PE,PE PBA group (60.9%, 67.4%), but there was no significant difference (P0.05). Serum total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), before and after treatment The biochemical indexes such as globulin (GLB) were significantly lower than those before treatment (P0.001). After treatment, the (PA) of pre-albumin in PE group was higher than that before treatment, and that in, PE PBA group and PE DPMAS group was lower than that before treatment, the difference was statistically significant (P0.05). Prothrombin time (PT) in PE group was lower than that before treatment (P0.05 PT in), PE PBA group was lower than that before treatment, PT in, PE DPMAS group was slightly higher than that before treatment, but there was no significant difference (P0.05). The levels of serum K and Cl- in PE group were significantly lower than those before treatment (P0.001); PE group before and after treatment, but there was no significant difference in serum Na (P0.05) between), PE PBA,PE DPMAS group and pre-treatment group (P0.001). The levels of serum Ca2 in the three groups were significantly lower than those before treatment (P0.001), and there was significant difference before and after WBC,Hb,PLT treatment (P0.05). Conclusion PE alone and combined with PBA or DPMAS, can effectively improve the liver function and the rescue rate of patients with subacute severe hepatitis, and the combined treatment can save the plasma dosage of 2% and 3%, which is convenient for more patients to use, and can improve the liver function of patients with subacute severe hepatitis. PE combined with DPMAS had the least effect on the decrease of serum Cl-,Ca2 and Hb, and had better clinical application value.
【作者单位】：江西省九江市第一人民医院肝病科;桂林市第三人民医院肝病科;桂林市妇女儿童医院;
【基金】：广西壮族自治区卫生厅立项课题(Z2013438) 桂林市科技局立项课题(20140120-9-1)
【分类号】：R512.62

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