不同人工肝方法治疗亚急性重型肝炎的疗效对比研究?

目的：观察血浆置换(PE)、血浆置换联合血浆胆红素吸附(PE+PBA)与血浆置换联合双重血浆分子吸附系统(PE+DPMAS)治疗亚急性重型肝炎的临床疗效,探讨重型肝炎的最佳人工肝治疗方案。方法统计同期收治的应用人工肝治疗的140例乙型肝炎病毒(HBV)感染亚急性重型肝炎病例,按照 PE、PE+PBA、PE+DPMAS 分为3组,对比3组患者治疗前、后临床症状及血常规、电解质和主要生化指标的变化。结果PE+DPMAS 组治疗有效率70.8%,稍高于 PE、PE+PBA 两组(60.9%、67.4%),但差异无统计学意义(P >0.05)；治疗前、后3组患者血清总胆红素(TBIL)、丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、球蛋白(GLB)等生化指标较治疗前明显下降(P <0.001),治疗后 PE 组前清蛋白(PA)较治疗前升高,PE+PBA 组和 PE+DPMAS 组均较治疗前降低,差异有统计学意义(P <0.05)；PE 组凝血酶原时间(PT)较治疗前下降(P <0.05),PE+PBA 组 PT 较治疗前下降,PE+DPMAS 组 PT 较治疗前稍升高,但差异无统计学意义(P >0.05)；PE 组血清 K+、Cl-较治疗前明显降低(P <0.001)；PE 组治疗前、后血清 Na+差异无统计学意义(P >0.05),PE+PBA、PE+DPMAS 组血清 Na+较治疗前降低(P <0.001)；3组血清 Ca2+均较治疗前降低,差异有统计学意义(P <0.001)；血常规 WBC、Hb、PLT 治疗前、后比较差异有统计学意义(P <0.05)。结论PE 单独应用和联合 PBA 或 DPMAS,均可有效改善亚急性重型肝炎患者的肝功能,提高救治率；联合治疗可节省血浆用量2/3,方便更多患者使用；PE 联合 DPMAS 对患者血清 Cl-、Ca2+及 Hb 下降的影响幅度最小,具有更佳的临床应用价值。

Comparative study of efficacy of different types of artificial liver treatments in management of hepatitis B-associated subacute severe hepatitis

Objective To observe the clinical efficacy of plasma exchange(PE),PE combined with plasma bilirubin absorp-tion(PE+PBA),and PE combined with double plasma molecule absorption system(PE+DPMAS),to investigate the best treat-ment options for the patients of hepatitis B-associated subacute severe.Methods Totally 140 patients who had hepatitis B-associat-ed were randomly divided into a PE group,a PE+PBA group,and a PE+DPMAS group.The dinical symptoms and blood rontine, electrolytc and the main biochemical indexes were recorded both before and after treatment and compared among the three groups. Results The total effective rate was higher in the PE +DPMAS group than in the PE group and PE+PBA group,which were 70.8%,60.9%,67.4% respectively,but there was no significant difference(P >0.05).compared with before treatment,serum total bilirubin (TBIL),alanine aminotransferase (ALT),aspartic acid amino shift enzyme (AST),valley aminoacyl transfer peptidase (GGT),alkaline phosphatase (ALP),globulin (GLB)and other biochemical indexes decreased significantly after treatment in 3 groups (P <0.001).PA was increased in the PE group and decreased in the PE+PBA and PE+DPMAS group after treatment,the differences were significant(P <0.05).After treatment,PT was shortened in the PE group,the differences were significant(P <0.05),but there were no significant difference between the PE+PBA and PE+DPMAS groups(P >0.05).Serum K+ and Cl- was obviously declined after treatment in the PE group,there was significant difference(P <0.001).Serum Na+ was obviously declined after treatment between the PE + PBA and PE + DPMAS groups (P < 0.001 ),but the difference was no significant in the PE groups.Serum Ca2+ was significantly decreased in the three groups of patients after treatment(P <0.001).WBC,Hb and PLT were significantly statistical difference after treatment(P <0.05).Conclusion The three groups also can improve liver function and the treatment rate for the patients of subacute hepatitis B-associated severe hepatitis.PE+PBA and PE+DPMAS groups can effective-ly reduce two thirds of the overall usage of the plasma.PE+DPMAS groups that the quantity of Cl- ,Ca2+ ,Hb decline much least in the three groups show larger value in the clinical application.