不同人工肝方法治疗乙型肝炎肝衰竭的疗效对比分析  

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

作　　者：刘凤华[1] 贺玉凯[1] 李庆方[1] 王思奎[1] 

机构地区：[1]聊城市人民医院感染科,山东省聊城市252000

出　　处：《世界华人消化杂志》2013年第19期1871-1876,共6页World Chinese Journal of Digestology

摘　　要：目的:观察血浆置换(plasma exchange,PE)、血浆胆红素吸附(plasma specific bilirubin adsorption,PBA)与PE+PBA(联合组)治疗乙型肝炎肝衰竭的临床疗效,探讨乙型肝炎肝衰竭的最佳人工肝治疗方法.方法:回顾性分析乙型肝炎肝衰竭患者150例,分为PE组、PBA组、联合组,观察3组患者治疗前后丙氨酸转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、白蛋白(albumin,ALB)、凝血酶原时间(prothrombin time,PT)、凝血酶原时间活动度(prothrombin time activity,PTA)、肌酐(creatinine,Cr)和血氨的水平,并观察不良反应的发生率.结果:(1)联合组总有效率65.45%,高于PE组和PBA组的62.5%和59.58%,但差异无统计学意义(P>0.05);(2)PE组、PBA组、联合组患者治疗前及治疗后4hTBIL分别为:410.3mol/L±208.6mol/Lvs292.5mol/L±175.4mol/L,432.7mol/L±242.5mol/Lvs298.8mol/L±201.7mol/L,468.2mol/L±241.6mol/Lvs288.5mol/L±184.5mol/L,治疗后3组TBIL均明显下降(P<0.05),下降幅度3组间差异无意义;(3)联合组和PE组治疗后PT缩短,PTA升高(P<0.05),两组间差异无意义(P>0.05);(4)3组患者治疗后血氨均显著降低(P<0.05),但3组间无显著统计学差异(P>0.05);(5)3组患者治疗后Cr均下降(P<0.05),但3组间差异无统计学意义(P>0.05);(6)未发生严重不良反应;(7)单次血浆用量,联合组1107.1mL±212.3mL,明显少于PE组的2911.5mL±352.3mL(P<0.05).结论:PE+PBA应用血浆量少,治疗乙型肝炎肝衰竭安全、有效.AIM： To investigate the clinical efficacy of plas- ma exchange （PE）, plasma bilirubin adsorption （PBA）, and PE combined with PBA in the treat- ment of hepatitis B-associated liver failure. METHODS： The clinical data for 150 patients with hepatitis B-associated liver failure were ret- rospectively analyzed. These patients were ran- domly divided into a PE group, a PBA group, and a PE ＋ PBA group. The volume of plasma consumed once, the effective rate, liver function, alanine aminotransferase （ALT）, total bilirubin （TBIL）, albumin （ALB）, prothrombin time （PT）, prothrombin time activity （PTA）, creatinine （Cr） and plasma ammonia were recorded both before and after treatment and compared among the three groups. The incidence of adverse reactionswas also observed RESULTS： The total effective rate was higher in the combination group than in the PE group and PBA group （65.45% vs 62.5%, 59.58%）, but the difference was not statistically significant （both P 〉 0.05）. TBIL was significantly decreased 4 hours after treatment compared to pre-treatment values in the PE, PBA and combination groups （410.3 μmol/L± 208.6 μmol/L vs 292.5 μmol/L ±175.4 μmol/L, 432.7 μmol/L±242.5 μmol/L vs 298.8 μmol/L ±201.7 μmol/L, 468.2 μmol/L± 241.6 μmol/L vs 288.5 μmol/L ± 184.5 μmol/L, all P 〈 0.05）, but the decline showed no signifi- cantly statistical difference among the three groups. After treatment, PT was significantly shortened and PTA was increased in the com- bination group and PE group （both P 〈 0.05）, but the changes showed no significant differ- ence between the two groups （both P 〉 0.05）. In the PBA group, PT was increased and PTA was decreased after treatment, but the differences were not significant （P 〉 0.05）. Blood ammonia and Cr were significantly decreased in the three groups of patients after treatment （all P 〈 0.05）, although there was no significantly statistical difference among the three groups. No serious adverse reactions oc

关 键 词：肝衰竭 人工肝 血浆置换 血浆胆红素吸附 联合治疗 

分 类 号：R575.3[医药卫生—消化系统]