血浆置换治疗慢性乙型重型肝炎的临床观察

目的探讨血浆置换治疗慢性重型肝炎的疗效。方法118例慢性重型肝炎患者被随机分为对照组和治疗组，后者加用血浆置换治疗。采用ELISA法检测患者血清细胞间粘附分子-1（sICAM-1）和白介素-18（IL-18）水平。结果在血浆置换治疗后，治疗组患者临床症状显著改善，血清sICAM-1由治疗前548．26±150．53μg／L降至228．32±132．15μg／L，血清IL-18由治疗前723．64±160．25μg／ml降至治疗后312．53±121．39μg／ml，血清TBIL由治疗前546．11±174．86μmol／L降至178．43±87．74μmol／L，凝血酶原活动度由治疗前22．84±11．13％升至治疗后36．79±15．19％，上述指标的变化均有统计学意义（P〈0．05）。60例治疗组患者治愈41例（68．3％），19例（中期7例，晚期12例）死亡，58例对照组患者治愈率为48．3％（28／58），30例（早期7例，中期11例和晚期12例）死亡（P〈0．01）。结论血浆置换治疗慢性重型肝炎患者疗效可靠，能显著降低血清中炎性介质水平，减轻免疫反应对肝细胞的损伤，提高患者的治愈率。

Clinical observation of plasma exchange in treating patients with chronic severe hepatitis B

Objective To explore the therapentic effect of plasma exchange （PE） in treating patients with chronic severe hepatitis B. Methods 118 patients with chronic severe hepatitis B were divided into control （n=58） and PE treatment group（n=60）. Serum soluble intercellular adhesion molecule-1（sICAM-1） and interleukin-18（IL-18） were examined by ELISA. Results After plasma exchange treatment,the clinical symptoms was remarkably improved,serum slCAM-I decreased from 548.26±150.53μg/L to 228.32±132.15μg/L,the serum IL-18 decreased from 723.64±160.25 pg/ml to 312.53±121.39pg/ml,the serum TBIL decreased from 546.11±174.86 I~mol/L to 178.43±87.74 μmol/L and the prothrombin time actitivty increased from 22.84±11.13% to 36.79±15.19%（P〈0.05）. The survival rate in PE group was 68.3% （41/60）,much higher than in control （48.3%,28/58,P〈0.05）. Condusion The plasma exchange is effective in treating patients with chronic severe hepatitis B.