拉米夫定联合血浆置换治疗乙型肝炎相关慢加急性肝衰竭的疗效分析

目的观察拉米夫定联合血浆置换治疗乙型肝炎相关慢加急性肝衰竭的临床疗效。方法选择乙型肝炎相关慢加急性肝衰竭患者92例,随机分为2组,治疗组47例,对照组45例。2组采用类似的内科基础治疗,均给予拉米夫定100 mg/d,治疗组加血浆置换,采用终末期肝病评分模型（MELD）,比较2组患者在MELD〈30、30≤MELD〈40和MELD≥40 3个亚组中的存活率的差异。结果治疗组总存活率为63.82%,而对照组总存活率为44.44%（χ2=4.31,P〈0.05）;在30≤MELD〈40亚组中治疗组存活率为71.42%,而对照组存活率为38.10%（χ2=4.71,P〈0.05）,在MELD〈30和MELD≥40亚组中,治疗组存活率与对照组分别相比,差异无统计学意义（P〉0.05）。结论 30≤MELD〈40的乙型肝炎相关慢加急性肝衰竭患者采用拉米夫定联合血浆置换治疗能提高患者存活率。

Evaluation of the therapeutic efficacy of lamivudine combined with plasma exchange for treating acute-on-chronic hepatitis B liver failure

Objective To observe the clinical effects of lamivudine antiviral therapy combined with plasma exchange in patients with acute-on-chronic hepatitis B liver failure.Methods Forty-seven patients（treatment group） were administered lamivudine and underwent plasma exchange.An additional forty-five patients（control group） were administered lamivudine but no plasma exchange.Otherwise,all patients received the same basic medical treatment.The two groups were further divided into three sub-groups according to the model for end-stage liver disease（MELD） score：30,30-39,and ≥40.The significance of differences in survival rates between the groups and sub-groups was determined by the χ2 test.Results The overall survival rate was significantly better in the treatment group（63.82% vs.control group：44.44%;χ2=4.31,P0.05）.Within the treatment group,the survival rates were highest in the 30-39 MELD score sub-group（71.42%）,which was significantly different from survival rate in the same sub-group of the controls（vs.38.10%;χ2=4.71,P0.05）.The other two MELD score sub-groups showed no significant differences between the treatment and control groups（all P0.05）.Conclusion Combined therapy consisting of lamivudine treatment and plasma exchange can improve the survival rate of patients with acute-on-chronic hepatitis B liver failure who have MELD scores between 30 and 39.