双重血浆吸附联合血浆置换治疗慢加急性乙型肝炎肝衰竭患者临床疗效研究*

目的 探讨应用双重血浆吸附联合血浆置换治疗慢加急性乙型肝炎肝衰竭患者的疗效。方法 2016年9月～2017年10月本院感染病科收治的60例慢加急性乙型肝炎肝衰竭患者被随机分为对照组30例和观察组30例,在综合治疗的基础上分别接受血浆置换和双重血浆吸附联合血浆置换治疗,观察12周。结果 在治疗12周末,观察组凝血酶原时间活动度为(75.3±2.8)%,血清白蛋白水平为(37.0±3.0)g/L和血清总胆红素为(180.2±93.0)μmol/L,与对照组【分别为(60.2±2.1)%、(33.6±2.5)g/L和(232.0±98.3)μmol/L,P＜0.05]比,差异显著;观察组外周血血红蛋白和血小板计数分别为(103.2±22.1)g/L和(80.2±5.9)×10⁹/L,血钾、钠和氯分别为(3.7±0.8)mmol/L、(137.1±5.0)mmol/L和(99.0±7.2)mmol/L,血肌酐水平为(73.2±14.8)μmol/L,与对照组比,无显著差异【分别为(102.6±15.3)g/L、(75.5±6.0)×10⁹/L、(3.7±0.5)mmol/L、(137.5±8.0)mmol/L、(99.1±5.7)mmol/L和(73.5±15.5)μmol/L,P＜0.05】;在治疗12周末,观察组病死率为16.7%,显著低于对照组的33.3%(P＜0.05)。结论 使用双重血浆吸附联合血浆置换治疗慢加急性乙型肝炎肝衰竭患者能够降低近期病死率,其远期效果值得观察。

Clinical efficacy of double plasma adsorption and plasma exchange in treatment of patients with acute-on-chronic hepatitis B liver failure

Objective The aim of this study was to investigate the clinical efficacy of double plasma adsorption and plasma exchange(PE)in treatment of patients with acute-on-chronic hepatitis B liver failure(ACLF).Methods 60 patients with ACLF were recruited in this study between September 2016 and October 2017,and were randomly divided into control group(n=30)and observation group(n=30).The patients in the observation group were treated with double plasma adsorption combined with PE,and those in the control group were treated with PE alone.All patients were followed-up for 3 months.Results At the end of 12 weeks,prothrombin time activity,serum albumin and bilirubin levels in the observation group were(75.3±2.8)%,(37.0±3.0)g/L and(180.2±93.0)μmol/L,significantly different as compared to(60.2±2.1)%,(33.6±2.5)g/L and(232.0±98.3)μmol/L,respectively,P<0.05]in the control;blood hemoglobin and platelet counts were(103.2±22.1)g/L and(80.2±5.9)×109/L,blood potassium,sodium and chlorine levels were(3.7±0.8)mmol/L,(137.1±5.0)mmol/L and(99.0±7.2)mmol/L,and serum creatinine level was(73.2±14.8)μmol/L,not significantly different as compared to those in the control(102.6±15.3)g/L,(75.5±6.0)×10^9/L,(3.7±0.5)mmol/L,(137.5±8.0)mmol/L,(99.1±5.7)mmol/L and(73.5±15.5)μmol/L,respectively,P<0.05];the fatality rate in the observation was 16.7%,much lower than 33.3%in the control(P<0.05).Conclusion The application of double plasma adsorption and PE in the treatment of patients with ACLF caused by hepatitis B infection might reduce the short-term mortality,which warrants further investigation.