血浆置换治疗慢性重型乙型肝炎的疗效探讨

目的观察血浆置换(plasma exchange,PE)治疗慢性重型乙型肝炎的疗效。方法选择天津塘沽传染病医院76名慢性重型乙型肝炎住院患者。随机分为治疗组和对照组,治疗组在内科综合治疗基础上联合PE,对照组予内科综合治疗,疗程为1个月。观察治疗前、后临床症状、生化指标变化和乙肝病毒-DNA(HBV-DNA)滴度的改变,以及1个月的死亡率。结果PE联合基础治疗,其中毒症状及生化指标均明显改善,降低HBV-DNA载量,提高存活率,降低病死率,与对照组相比有显著性差异(P<0.01,P<0.05)。结论PE联合内科基础治疗既可以改善重型病毒性肝炎患者的肝功能和凝血功能状态,减轻异常的免疫反应,维持内环境稳定,又可以快速降低患者的血清病毒载量,是一种值得更深入研究的新方法。

Clinical Analysis of Plasma Exchange on Chronic Severe Hepatitis B

Objective To study the efficacy of plasma exchange(PE)in the treatment of chronic severe hepatitis B.Methods Seventy-six cases with chronic severe hepatitis B were divided into two groups: treatment group and control group.The treatment group combined with PE based on physical treatment, control group was only performed physical treatment, which lasted for 1 month. Observe the symptom, changes of biochemical index, changes of titer of HBV-DNA and mortality in a month. Results The toxic symptom and biochemical index were improved significantly through PE combined basic treatment, HBV-DNA load was lowered, survival rate was increased and mortality was decreased, and there was significant difference compared with control group (P<0.01,P<0.05).Conclusion Physical treatment with PE can improve liver function and state of coagulation in patients with severe viral hepatitis, and reduce abnormal immune activity, keep internal environment stable, furthermore can decrease serum virus load quickly, so it is worth further study.