各型重型病毒性肝炎疗效分析

目的探讨重型病毒性肝炎的综合性治疗方案，提高存活率。方法分析近 ２０年收治的 １０２０例各型重型肝炎疗效。结果第一阶段基础治疗为主的１０９例存活率３０．２８％（３３／１０９）；第二阶段为中西医结合的综合性治疗，并加用胎肝细胞悬液或注射用促肝细胞生长素，近４年又并用人工肝血液净化治疗，共９１１例，存活率６０．１５％（５４８／９１１）。两组比较其存活率差异有显著意义（Ｐ＜０．００１）。１０２０例重型病毒型肝炎中，急性、亚急性重型肝炎２１９例，占２１．４７％。慢性重型肝炎８０１例，占７８．５３％。按入院时病程早、中、晚三期统计，病程早期接受治疗者４４６例，存活率７７．１３％（３４４／４４６）；中期４０４例，存活率５２．７２％（２１３／４０４）；晚期１７０例，存活率１４．１２％（２４／１７０）。早期、中期与晚期比较，差异有显著意义（Ｐ＜０．００１）。凝血酶原活动度与存活率成正相关。结论重型病毒性肝炎早期联合细胞因子治疗，可阻断免疫病理对肝细胞的损害；中期配合人工肝血液净化。在治疗过程中应积极预防和治疗并发症，是提高存活率的关键。

A retrospective analysis of therapeutic outcome of various types of severe virus hepatitis

Objective To explore combined therapeutic schemes for severe virus hepatitis and to raise survival rate. Methods The therapeutic outcomes of different schemes were analyzed in 1020 cases of severe viral hepatitis treated in our hospital in recent twenty years. The treatments were classified as basic and combination of Chinese traditional and Western medicine therapies in which embryonic liver cell suspend liquid or hepatic growth factor, or/and artificial liver as blood cleaner were also used for the latter. Results The survival rate was 30.28% (33/109) treated by basic procedures and 60. 15% (548/911) by combined procedures. There was obvious statistical difference in survival rate between the two groups (P<0.001). Among all the patients, 219 (21.47%) suffered from acute or sub-acute severe hepatitis, 801 (78.53%) chronic severe hepatitis; 446 started their treatment at the early stage of the disease and the survival rate was 77. 13% (344/446); 404 at the mid stage and 170 at the late stage and the survival rates were 52.72% (213/404) and 14.12% (24/170), respectively. The survival rate for the patients treated at the early or the mid stage was much higher than that at the late stage (P< 0.001), and had a positive correlation with the activity of prothrombin. Conclusions The combined therapies used in present study are effective to raise the survival rate of the patients with severe virus hepatitis. Early treatment is extremely important for the patients' prognosis.