平均每日血浆负荷量对人工肝治疗慢加急性肝衰竭的预后影响分析

目的 探讨应用人工肝血浆置换治疗乙型肝炎慢加急性肝衰竭患者过程中平均每日血浆负荷量(ADP)差异对预后的影响,为提高乙型肝炎慢加急性肝衰竭的人工肝治疗效果提供依据.方法 采用回顾性研究方法对98例接受人工肝血浆置换治疗的乙型肝炎慢加急性肝衰竭患者的临床资料进行分析,明确可能影响乙型肝炎慢加急性肝衰竭患者的预后因素,并进行非条件Logistic回归分析进一步明确影响患者预后的因素.结果 单因素统计分析显示,总胆红素(TBil)、白蛋白、总胆固醇、乙肝病毒脱氧核糖核酸水平、1周ADP是否>300 ml、2周ADP是否>400 ml为影响预后的因素(P<0.05).多因素回归分析显示:TBil、2周ADP>400 ml为影响人工肝血浆置换治疗乙型肝炎慢加急性肝衰竭患者90 d预后的独立预测因素,以TBil回归系数为0.008,2周ADP回归系数为-1.832.结论 TBil和2周ADP是否>400 ml是人工肝血浆置换治疗乙型肝炎慢加急性肝衰竭患者预后的影响因素,TBil为危险因素,2周ADP>400 ml为保护性因素.

Analysis on the effect of average daily plasma load on the prognosis of acute and chronic liver failure in hepatitis B patients treated by artificial liver support system

Objective To discuss the prognostic factors of artificial liver plasmapheresis(PE) for acute and chronicliver failure with hepatitis B virus infection and to provide reference for internal medicine treatment of acute and chronicliver failure.Methods A retrospective analysis was performed on 98 cases with acute and chronic liver failure.All cases were treated by PE, and the potential prognostic factors were assessed by using conditional Logistic univariate and multivariate regression.Results Univariate regression indicated that the levels of TBil, ALB, CHO and HBV DNA, whether the daily average plasma load within a week was>300 ml, and whether the daily average plasma load within 2 weeks is>400 ml, were the prognostic factors.Multivariate analysis indicated that the regression coefficient of TBil levels was 0.008, and that of daily average plasma load within 2 weeks was-1.832.The prognostic model was built, and ROC curves were plotted.Conclusion TBil levels and whether the daily average plasma load within 2 weeks is>400 ml are the prognostic factors of PE for acute plus chronic liver failure.The TBil level is a risky factor, and that the daily average plasma load>400 ml within 2 weeks is a protective factor.