血浆置换治疗慢性乙型重型肝炎疗效评价及其影响因素

目的探讨血浆置换（PE）治疗慢性乙型重型肝炎的治疗效果及其影响因素。方法回顾性对比分析104例慢性乙型重型肝炎患者PE＋药物（治疗组）与60例单纯药物治疗（对照组）治疗前后病情变化和疗效影响因素。结果治疗组有效率为67．31％，明显高于对照组41．67％（P〈0．05）。慢性乙型重型肝炎早、中、晚期患者PE治疗的有效率分别为86．21％、47．06％和33．33％（P〈0．01）；凝血酶原活动度（PTA）在30％-40％的患者疗效明显高于PTA低于20％和20％～30％的患者（P均〈0．01）；年龄〈50岁患者PE治疗的有效率为78．78％（52／66）明显高于年龄≥50岁患者的有效率47．37％（18／38）（P〈0．01）；肝硬化基础上发生的慢性乙型重型肝炎的治疗有效率（36．36％）明显低于非肝硬化基础上发生的慢性乙型重型肝炎有效率（81．69％），两组差异显著（P〈0．01）。结论血浆置换是慢性乙型重型肝炎安全有效的治疗方法。年龄≥50岁、低凝血酶原活动度和肝硬化基础是PE治疗慢性乙型重型肝炎疗效的阴性预测因子。此外，PE治疗早晚和次数也是影响疗效的重要影响因素。

The efficacy and influential factors of plasma exchange for treatment of chronic hepatitis B gravis

Objective To evaluate the efficacy and influential factors of plasma exchange （PE） for chronic hepatitis B gravis. Methods Retrospective and comparative analysis was carried out on changes of patients with chronic hepatitis B gravis before and after treatment and the influential factors to the efficacy. One hundred and four patients treated with a combined therapy of conventional medicines and PE were enrolled in the treatment group, while 60 patients treated with only conventional medicines were enrolled in the control group. Results The effective rate were 67.31% and 41.67% in the treatment group and control group, respectively （ P 〈 0.05 ）. The efficacy of PE treatment were 86.21%, 47.06% and 33.33 % for patients with chronic hepatitis B gravis at early, midterm and advanced stages, respectively （P 〈 0.01 ）. The lower the prothrombin activity （PTA） of the patients with, the lower the efficacy were. PE efficacy for patients 〈50 years was higher than those≥50 years （78.78% vs 47.37% , P 〈0.01 ）. PE for eases with cir- rhosis before chronic hepatitis B gravis had lower effective rate than those without cirrhosis basis （36.36% vs 81.69%, P 〈 0.01 ）. Conclusions PE is a safe and effective therapy for patients with chronic hepatitis B gravis. Patient≥50 years, with lower PTA and cirrhosis basis are negative predicting factors to PE therapy. In addition, the starting time and times of implementation of PE have great influence on its efficacy as well.