血浆置换联合持续性血浆滤过吸附术对HBV相关慢加急性肝功能衰竭的疗效

目的探讨血浆置换联合持续性血浆滤过吸附术（PE + DPMAS）和单纯血浆置换治疗（PE）对慢性乙型病毒性肝炎相关慢加急性肝功能衰竭（ACLF）的疗效，并探寻节省血浆的方法。 方法98例慢加急性肝功能衰竭患者均在内科综合治疗的基础上随机分组纳入研究，其中治疗组（PE + DPMAS组）患者51例应用血浆置换（PE）联合DPMAS；对照组（PE组）患者47例，行单纯PE治疗，5～7 d进行1次，平均每例应用2～3次，比较两组患者治疗前后临床症状和生化指标的改善。 结果治疗后PE + DPMAS组和单纯PE组患者TBil、ALT、AST、GGT、ALP、GLB和PT等主要生化指标较治疗前均有显著下降，差异具有统计学意义（P均< 0.05）；PE组患者血清K⁺、Cl^-较治疗前均显著降低（t = 4.015、4.186，P均< 0.001）；PE + DPMAS组患者血清Na⁺较治疗前降低，差异具有统计学意义（t = 4.715、P = 0.000）；两组患者血清Ca²⁺均较治疗前降低，差异均具有统计学意义（PE + DPMAS组：t = 4.306、P = 0.000，PE组患者：t = 16.528、P = 0.000）。98例患者总治疗有效率66.3%，其中PE + DPMAS组患者为70.6%，PE组患者为61.7%，两组差异无统计学意义（χ² = 0.865、P = 0.352）。与PE组比较，PE + DPMAS组患者可节省50%～60%的血浆，且皮肤瘙痒、荨麻疹等不良反应的发生率由80.8%降至17.6%，口周麻木的发生率由91.4%降至74.5%。 结论PE联合DPMAS和单纯PE治疗均可有效改善ACLF患者的肝脏功能，PE + DPMAS治疗可更好地降低电解质离子水平和不良反应发生率，且安全性更佳，从而提高患者近期的生存率。

Effects of plasma exchange combined with double plasma molecule absorption system in treatment for patients with HBV related acute on chronic live failure

ObjectiveTo investigate the effects of plasma exchange combined with double plasma molecule absorption system (PE + DPMAS) and only plasma exchange (PE) on patients with HBV related acute on chronic live failure, and to search a way of saving plasma. MethodsTotal of 98 cases with acute-on-chronic liver failure based on internal medicine comprehensive treatment were randomly divided, 51 cases treated by PE combined with DPMAS were collected as PE + DPMAS group, and 47 cases treated by only PE were collected as PE group, every case was treated for 2 to 3 times (every 5 to 7 days for one time). The improved condition on clinical symptoms and serum biochemical indexes before and after treatment in both groups were compared, respectively. ResultsThe levels of serum TBil, ALT, AST, GGT, ALP, GLB and PT were significantly decreased after treatment in both groups (all P < 0.05). The levels of serum K⁺ and Cl^-were significantly decreased in patients of PE group (t = 4.015, 4.186; both P < 0.001). Compared with before treatment, the levels of serum Na⁺decreased after treatment in patients of PE + DPMAS group (t = 4.715, P = 0.000). The levels of serum Ca²⁺ were decreased after treatment in both groups, with significant difference (PE + DPMAS group: t = 4.306, P = 0.000; PE group: t = 16.528, P = 0.000). The total effective rate was 66.3% in all 98 cases, which was 70.6% in PE + DPMAS group, and 61.7% in PE group. The effect rates of PE + DPMAS group and PE group were not different significantly (χ²= 0.865, P = 0.352). Compared with PE group, PE + DPMAS treatment could save 50% to 60% plasma, with the incidence rates of skin pruritus urticaria and perioral numbness decreased from 80.8% to 17.6%, and 91.4% to 74.5%, respectively. ConclusionBoth PE combined with DPMAS treatment and only PE treatment could improve liver functions for patients with acute-on-chronic liver failure, while PE + DPMAS treatment could reduce the levels of electrolyte ion and the incidence rate of adverse reactions, with better security, so as to improve the recent survival rate of the patients.