人工肝支持系统治疗乙型肝炎慢加急性肝功能衰竭的临床研究

发布时间：2018-05-18 00:08

  本文选题：人工肝 + 病毒性肝炎　； 参考：《华中科技大学》2013年硕士论文

【摘要】：目的通过回顾性研究，探讨不同人工肝支持系统对乙型肝炎慢加急性肝功能衰竭临床疗效差异。 方法选择2011年1月至2012年6月在武汉同济医院感染科住院的乙型肝炎慢加急性肝功能衰竭患者119例，共进行人工肝治疗179人次，按照人工肝类型分为3组，血浆胆红素吸附（Plasma bilirubin absorption,简称PP）组39例，血浆置换（Plasma exchange,简称PE）组44例，血浆胆红素吸附联合血浆置换（简称PP+PE）组36例，记录人工肝治疗当日前后及治疗后1周患者血生化指标及患者出院时临床疗效，比较不同组的疗效差异。 结果①PP+PE清除总胆红素效果更为明显，治疗后总胆红素清除率为60%，高于PE组、PP组的43%、34%，差异有统计学意义。治疗后1周PP+PE组、PE组胆红素改善幅度下降，PP+PE组治疗后1周胆红素下降幅度高于PE，差异无统计学意义。对于直接胆红素（DBIL）、间接胆红素（IBIL）清除率PP+PE、PE基本一致，而PP清除IBIL高于DBIL。②PP+PE组胆汁酸清除率为33%，高于PE组、PP组的17%、25%，差异有统计学意义。③肝性脑病Ⅱ度以下，PP+PE与PE治疗后肝性脑病的症状好转，血氨明显下降，但下降比例两组之间差异无统计学意义，而肝性脑病Ⅲ度以上，两组人工肝治疗后肝性脑病的症状无改善，血氨反而上升。④PP+PE、PE治疗后凝血功能明显改善，PP治疗后PTA低于治疗前水平，1周后凝血功能明显恢复。PP+PE组、PE组治疗1周后PTA改善幅度下降，PP+PE组治疗后1周PTA上升幅度高于PE，差异无统计学意义。⑤PP+PE、PE治疗后K+改变不明显，可以纠正低Na+血症；PP对低Na+无治疗作用。PP+PE、PE治疗后1周Na+降低，恢复到治疗前水平。⑥PE治疗后患者好转率为52.5%（21/40），低于PP+PE的63.9%（23/36），差异无统计学意义。 结论相对PE来说，PP+PE增加了胆红素、胆汁酸的清除，相对PP来说，克服了PP治疗后凝血功能下降的不足，拓宽了PP的适用范围，适用于凝血功能障碍的肝衰竭患者。PP+PE、PE能纠正低钠血症，，PP无治疗作用。
[Abstract]:Objective to investigate the clinical efficacy of different artificial liver support systems in patients with chronic hepatitis B and acute hepatic failure. Methods from January 2011 to June 2012, 119 patients with chronic hepatitis B and acute hepatic failure were selected and divided into 3 groups according to the type of artificial liver. There were 39 patients in plasma bilirubin absorption group, 44 patients in plasma exchange group, 36 patients in plasma bilirubin adsorption and plasma exchange group. The blood biochemical indexes of patients before and after treatment and the clinical efficacy at discharge were recorded before and after the treatment of artificial liver, and the difference of therapeutic effects between different groups was compared. Results the clearance rate of total bilirubin in 1PP PE group was more obvious than that in PP group (P < 0.05). The clearance rate of total bilirubin in PE group was higher than that in PP group (P < 0.05). The improvement of bilirubin in PP PE group was higher than that in PE1 week after treatment, and there was no significant difference between PP PE group and PE group. For direct bilirubin, indirect bilirubin and bilirubin IBIL, the clearance rate of PP PEPE was basically the same. The clearance rate of bile acid in PP group was higher than that in DBIL.2PP PE group (33%), and the clearance rate of bile acid in PP group was higher than that in PP group. The difference was statistically significant. 3 the symptoms of hepatic encephalopathy were improved and the blood ammonia was significantly decreased after treatment with PP PE and PE. However, there was no significant difference between the two groups in the proportion of decrease. However, there was no improvement in the symptoms of hepatic encephalopathy after artificial liver treatment in the two groups, but the degree 鈪

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