选择性血浆置换治疗慢性乙型重型肝炎86例疗效分析

目的探讨选择性血浆置换治疗慢性乙型重型肝炎的临床疗效。方法应用选择性血浆置换技术对86例慢性乙型重型肝炎患者进行共计173次人工肝-选择性血浆置换治疗,观察治疗前后患者临床症状和体征的变化以及不良反应,实验室检测患者治疗前后肝功能、肾功能、凝血功能以及血清电解质等指标,判断临床疗效,并与对照组52例患者比较肝炎不同时期采用血浆置换治疗的疗效。结果血浆置换治疗后,患者临床症状明显改善;患者ALT、AST、γ-GT、AKP、TBIL、DBIL、TBA等肝功能指标以及PT、INR、APTT等凝血功能指标均明显好转;治疗组早、中期有效率分别为83.33%和58.54%,总有效率51.16%,显著高于对照组的50.00%、31.82%和32.69%（P均〈0.05）。结论选择性血浆置换治疗能显著改善慢性乙型重型肝炎患者的临床症状及生化指标,尤其对早、中期患者疗效更好。

Clinical Observation of Artificial Liver Supporting Systems on the Treatment of Patients with Chronic Severe Hepatitis B

Objective To explore clinical effects of artificial liver supporting systems （ALSS） on the treatment of patients with chronic severe hepatitis B. Methods All 86 cases with chronic severe hepatitis B were treated with plasma exchange （ PE ）. The improvement in clinical symptoms, the level of liver function, renal function, electrolytes and coagulation function were determined before and after the treatment. The control group consisted of 52 similar patients treated by the conventional therapy. The therapeutic effects and side effects of PE in patients of different stages were observed. Results There were significant differences of clinical symptoms, the level of liver function, renal function, electrolytes and coagulation function before and after PE therapy. The level of ALT, AST, γ-GT, AKP, TBIL, DBIL and TBA fell back, the level of PT, INR and APTT rose up significantly after PE therapy. The general effective rate of PE therapy group was 51.16% （83.33% and 58.54% for the early and middle stage respectively）, the difference between the therapeutic group and control group was significant （P 〈 0.05 ）. Conclusion It is demonstrated that plasma exchange may improve the clinical symptoms and biochemical indexes of chronic severe hepatitis B, it is an effective and safe way for the treatment of patients with this disease, especially for patients in early or middle stage.