慢性重型肝炎患者经血浆置换治疗前后实验室指标分析  

Analysis of laboratory parameters of patients with chronic severe hepatitis before and after plasma exchange

作　　者：聂鑫[1] 许玲[1] 贺勇[1] 宋昊岚[1] 罗通行[1] 余萍[2] 高宝秀[1] 李贵星[1] 

机构地区：[1]四川大学华西医院实验医学科,四川成都610041 [2]四川大学华西医院传染科,四川成都610041

出　　处：《中国实验诊断学》2012年第12期2219-2222,共4页Chinese Journal of Laboratory Diagnosis

基　　金：四川省科技支撑项目(2010SZ0252)

摘　　要：目的通过分析慢性重症肝炎患者经血浆置换(PE)治疗前后的肝肾功能、血氨及电解质的变化,评价PE在治疗慢性重症肝炎患者中的作用。方法纳入我院2009年1月至2010年8月慢性重型肝炎患者共53例,经3次PE治疗,分PE前、第1次PE、第2次PE、第3次PE、出院时共5个时间点,采集患者血液,测定肝肾功能、血氨和电解质,以PE前数据为基础数据,将每个时间点数据与之进行对比分析。结果 1.PE治疗期间,慢性重型肝炎患者的白蛋白(ALB)均高于PE前(P<0.05),表现为升高的趋势变化;总胆红素(TB)、直接胆红素(DB)、丙氨酸氨基转移酶(ALT)、谷氨酸氨基转移酶(AST)、血氨(Ammon)、尿素(Urea)、肌酐(Crea)、半胱氨酸蛋白酶抑制剂C(Cys C)均低于PE前(P<0.05),表现为逐渐降低的趋势变化;钠(Na)、钾(K)、氯(Cl)经PE治疗,其变化无统计学意义(P>0.05)。2.第1次PE治疗慢性重型肝炎患者的TB、DB、ALT、AST、Ammon降低明显(P<0.05);第2次PE治疗,TB、DB、ALT、AST降低率高于第1次PE的降低率(P<0.05),而Ammon的降低率和第1次PE比较差异无统计学意义(P>0.05);第3次PE治疗,TB、DB、ALT、AST、Ammon降低率和第2次PE比较,降低率差异无显著性无统计学意义(P>0.05)。3.慢性重型肝炎患者经PE治疗,在出院时TB、DB、ALT、AST低于PE前(P<0.05),而ALB、Ammon、Urea、Crea、Cys C均高于PE前(P<0.05)。结论慢性重症肝炎患者经血浆置换可降低转氨酶和胆红素水平,短期内可降低Ammon、Urea、Crea和Cys C水平,但长期效果不理想。Objective To evaluate the therapeutical effect of plasma exchange（PE）on patients with chronic heavy hepatitis through analyzing their liver function,renal function and electrolytes changes before and after PE.Methods Between January 2009 to August 2010,we enrolled fifty-three inpatients with chronic severe hepatitis of our hospital,treated them with fresh frozen plasma to PE for three times and obtained five fasting blood of every patients for liver function,renal function,and electrolytes indicators measurement before PE,after every PE and on discharge.We compared all the indicators after every PE and on discharge with those before PE respectively.Results 1.During PE treatment,compared with serum results before PE,the albumin（ALB） levels after every PE and on discharge showed a significant increase（P0.05） with a trend to be higher while total bilirubin（TB）,direct bilirubin（DB）,glutamic transaminase（ALT）,aspartate aminotransferase（AST）,blood ammonia（AMON）,blood urea nitrogen（BUN）,creatinine（Crea） and cystatin C（Cys C） showed a significant decrease（P0.05） with a trend to be lower;serum electrolytes potassium（K）,sodium（Na） and chloride（Cl） levels did not differ（P0.05）.2.The TB,DB,ALT,AST,AMON level decreased significantly（P0.05） after the fist PE;decrease rates of TB,DB,ALT,AST after the second PE showed a significant increase（P0.05）compared with those after the fist one while the decrease rate of AMON did not differ（P0.05）;decrease rates of TB、DB、ALT、AST、AMON after the third PE showed no significantly difference（P0.05） from the second one.3.The TB,DB,ALT,AST levels on discharge showed a significant decrease（P0.05） compared with those before PE while the ALB,AMON,Urea,Crea,Cys C levels showed a significant increase（P0.05）.Conclusion PE is effective for reducing aminopherase and bilirubin level of paitients with chronic severe hepatitis to,but for AMON、Urea、Crea and Cys C,its effect are temporarily and its long-term e

关 键 词：血浆置换 重症肝炎 肝功能 血氨 肾功能 

分 类 号：R575.1[医药卫生—消化系统]