白蛋白置换治疗难治性肝炎高胆红素血症的研究  

Albuminpheresis treatment in viral hepatitic hyperbilirubinemia

作　　者：杨金龙[1] 郑水根[1] 夏子禹 吕萍[1] 卢培[1] 黄秋芳[1] 

机构地区：[1]上海市第八人民医院传染病科,肝病研究室,200233

出　　处：《上海医学》2001年第3期146-149,共4页Shanghai Medical Journal

基　　金：上海市科学技术发展基金! (9941190 45 )

摘　　要：目的　探讨白蛋白置换治疗难治性肝炎高胆红素血症的疗效和作用机理。方法　 84例病人随机分成治疗组 5 3例 ,对照组 31例。基本治疗给予强力宁 ;对照组在基本治疗基础上给予复方丹参 (或茵栀黄 )。治疗组在基本治疗基础上采用血液成分分离机 ,分离和去除部分含有胆红素等有害物质的血浆 ,回输血液有形成分 ,平均每次置换 30 0～ 40 0ml血浆 ,同时补充 30g白蛋白 ;每周置换 2次 ,4次为一疗程。结果　治疗组总有效率为 86 .8% ,高于对照组的 6 7.7% (P <0 .0 5 ) ,其中显效率 (4 3.4% )明显优于对照组 (19.4% ) (P <0 .0 5 ) ;急性肝炎治疗组的总有效率 (96 .7% )高于对照组 (78.6 % ) (P <0 .0 5 ) ,显效率 (6 3.3% )明显高于对照组 (2 8.6 % )(P <0 .0 5 )。在急、慢性肝炎治疗有效的病人中 ,治疗组每日SB下降均值 [分别为 (8.44± 7.2 2 )和 (4 .94±2 .5 9) μmol/L]幅度明显较对照组 [分别为 (3.0 4± 1.6 7)和 (1.6 9± 0 .72 ) μmol/L]增高 (分别为P <0 .0 5和P <0 .0 0 5 ) ;住院天数 [分别为 (5 4± 30 )和 (6 5± 2 4)d]则显著少于对照组 [分别为 (79± 14)和 (89± 2 1)d](P <0 .0 5 )。部分急、慢性肝炎病人治疗后CD4/CD8值明显上升 (P <0 .0 5和P <0 .0 1) ,IL 2上升 (P <0 .0 5 ) ,sILObjective To study the efficacy and mechanism of albuminpheresis in treatment of viral hepatitic hyperbilirubinemia. Methods 84 cases were randomly allocated into two groups:treatment group 53 cases, control groupl 31 cases. All cases received Poenline 80 ml in 10% glucose water l250 ml q.d. as the basic treatment,with compound Dan Shen or Yinzhihuang 20 ml/250 ml iv gtt. once daily in the control group. Cases in the treatment group recelived albuminipheresis, separated and removed the bilirubin and other nociception constituents from the plasma. This was reinfused,each pheresis averaging 300～400 ml plasma with replenishment of 30g albumin twice a week and four times constituted a course. Results The total effective rate of the treatment group(86.8%) was higher than that of the control(68.8%)( P <0.05), and the excellent response rate of the treatment group(43.4%) also was higher than that of the control(19.4%)( P <0.05). In cases with acute hepatitis, the total and excellent response rate of the treatment group(96.7% and 63.3% respectively) were significantly higher than those of the control(78.6% and 28.6% respectively)( P <0.05). In acute and chronic hepatitis,the mean fall of SB each day in the treatment group(8.44±7.22 and 4.94±2.59 μmol/L respectively) was all significantly higher than that(3.04±1.67 and 1.69± 0.72 μmol/L respectively) of the control ( P <0.05 and P <0.005 respectively), the duration of hospitalization of the treatment group(54±30d and 65±24d respectively) was significantly less than that(79±14 and 89±21 respectively) of the control( P <0.05). The level of IL 2, sIL 2R and endotoxin were detected in some of the treatment group and it was found that the IL 2 level was increased( P <0.05), sIL 2R decreased( P <0.05 and P <0.01 respectively), and the ratio of CD4/CD8 increased ( P <0.05 and P <0.01 respectively) when compared with that before treatment. In cases with acute hepatitis, the level of endot

关 键 词：白蛋白 血浆置换 高胆红素血症 病毒性肝炎 

分 类 号：R512.6[医药卫生—内科学]