血浆置换与胆红素吸附治疗肝衰竭的临床研究  

Therapeutic effects of plasma exchange and bilirubin adsorption for the treatment of patients with liver failure

作　　者：杨杰[1] 王惠明[1] 杨聚荣[1] 任姜汶[1] 王云燕[1] 何娅妮[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肾内科,重庆400016

出　　处：《中国血液净化》2010年第11期624-626,共3页Chinese Journal of Blood Purification

摘　　要：目的探讨血浆置换与胆红素吸附治疗肝衰竭的临床疗效和安全性。方法将25例肝衰竭的患者随机分为两组,吸附组(13例)采用血浆胆红素吸附治疗,置换组(12例)采用血浆置换治疗,血浆置换量(2500±500)ml/次。比较两组治疗前后胆红素、血浆白蛋白、凝血因子Χ、凝血功能、肿瘤坏死因子a(tumor necrosis factor-a,TNF-a)、白细胞介素1(interleukin-1,IL-1)的浓度变化,临床症状改善情况,同时观察治疗后不良反应及存活率。结果吸附组及置换组治疗后,胆红素、TNF-a和IL-1-均明显降低(均P<0.01),吸附组血浆白蛋白、凝血因子Χ轻度下降,置换组凝血因子Χ无降低。吸附组无一例发生出血、休克、过敏等严重并发症,置换组1例患者出现过敏性皮疹,1例发热,对症处理后均好转。结论血浆胆红素吸附能有效降低血清胆红素水平,降低炎症因子水平,改善肝衰竭患者预后,与血浆置换比较,血浆胆红素吸附无明显不良反应,不受血浆用量限制,无输血感染风险。Objective To compare the therapeutic effects of plasma exchange and bilirubin absorption in the treatment of liver failure patients. Methods Twenty-five patients with liver failure were randomly divided into two groups： bilirubin adsorption group （n= 13） and plasma exchange group （n = 12）. Serum samples were collected before and after the treatment, and the following clinical indicators were assayed： serum bilirubin, albumin, coagulation factor X, coagulation activities, tumor necrosis factor-α （TNF-α and interleukin-1β （IL -1β）. Adverse reactions related to the therapies were also observed. Results Both plasma exchange and bilirubin adsorption significantly reduced serum levels ofbilirubin, TNF-α and IL-1β, and the reductions had no significant differences between the two groups. However, serum albumin and coagulation factor X were slightly lower at the end of treatment in bilirubin absorption group than in plasma exchange group. No therapy-related adverse reactions including severe hemorrhage, shock, hypersensitivity occurred in bilirubin adsorption group but fever happened in one case during plasma exchange. Conelusion Plasma exchange and bilirubin adsorption have similar effects in lowering bilirubin and inflammatory cytokines. However, bilirubin adsorption has the advantages of no risk of blood transmissible diseases and rare side effects.

关 键 词：血浆置换 血浆胆红素吸附 肝衰竭 疗效 

分 类 号：R318.14[医药卫生—生物医学工程]