血浆置换治疗在慢性重型乙型肝炎中的疗效探讨  

The therapeutic effect of plasmapheresis in the treatment of chronic severe hepatitis B

作　　者：贺碧英[1] 龚作炯[1] 

机构地区：[1]武汉大学人民医院感染性疾病科,武汉430060

出　　处：《中国血液净化》2015年第7期429-432,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨血浆置换（PE）治疗对慢性重型乙型肝炎（CSHB）患者的血清炎性介质及肝功能的影响。方法分析2013年2月-2014年2月在武汉大学人民医院感染性疾病科接受治疗的CSHB患者的临床资料。对所有入组患者实施PE结合临床的综合治疗方式,其中每次置换3L同型新鲜的冰冻血浆。比较入组患者治疗前后的炎性指标、肝功能指标。结果本研究共纳入研究对象45例,平均年龄为42.3岁,治疗后患者的炎性指标包括CRP（28.5±11.3 mg/L vs.20.4±14.3 mg/L;t=3.613,P〈0.001）、TNF-α（275.4±50.9 vs.181.0±39.0;t=8.765,P〈0.001）、IL-6（351.9±41.5 pg/m L vs.252.9±34.8 pg/m L;t=12.262,P〈0.001）、IL-8（665.9±84.6 pg/m L vs.458.4±86.4 pg/m L;t=11.513,P〈0.001）水平均显著低于治疗前水平;入组患者治疗后的胆固醇（TCh）（2.1±0.3 mmol/L vs 2.5±0.8mmol/L;t=3.141,P〈0.001）、胆碱酯酶活力（CHE）（2635.9±984.6 U/m L vs 3448.4±566.3 U/m L;t=5.442,P〈0.001）、白蛋白（Alb）（28.6±3.5 g/L vs.31.2±2.7 g/L;t=8.753,P〈0.001）水平均显著高于治疗前,而PT（34.6±6.7 vs.26.6±4.3;t=6.741,P〈0.001）、丙氨酸转氨酶（ALT）（82.0±5.7 IU/L vs.55.9±5.0 IU/L;t=16.531,P〈0.001）、天门冬氨酸氨基转移酶（AST）（80.0±3.1 IU/L vs.53.4±2.4IU/L;t=15.563,P〈0.001）、总胆红素（TBIL）（15.7±0.82 mmol/L vs.13.4±1.3 mmol/L;t=10.326,P〈0.001）显著低于治疗前。结论 PE治疗能够显著改善CSHB患者的肝功能,改善机体炎症状况。Objective This retrospective study aimed to discuss the effect of plasmapheresis（PE） in the clearance of serum inflammatory mediators and recovery of liver function in chronic severe hepatitis B（CSHB）. Methods CSHB patients treated in our hospital in the period between 2013 and 2014 were retrospectively analyzed. Comprehensive therapy combined with PE was used to treat these patients. Every PE used 3L fresh frozen plasma of same blood type. Serum inflammatory mediators and liver function were compared before and after the treatment. Results A total of 45 patients（mean age 42.3 years old） were retrospectively analyzed. After the treatment, serum inflammatory mediators decreased significantly as compared with those before the treatment： CRP（20.4 ± 14.3 mg/L vs. 28.5 ± 11.3 mg/L; t=3.613, P〈0.001）, TNF- α（181.0±39.0 vs. 275.4±50.9; t=8.765, P〈0.001）, IL-6（252.9±34.8 pg/m L vs. 351.9±41.5 pg/m L; t=12.262,P〈0.001）, and IL-8（458.4±86.4 pg/m L vs. 665.9±84.6 pg/m L; t=11.513, P〈0.001）. After the treatment, serum total cholesterol（2.5 ± 0.8 mmol/L vs. 2.1 ± 0.3 mmol/L; t=3.141, P〈0.001）, cholineasterase activity（3448.4±566.3 U/m L vs. 2635.9±984.6 U/m L; t=5.442, P〈0.001）, and albumin（31.2±2.7g/L vs. 28.6±3.5 g/L; t=8.753, P〈0.001） increased, and PT（26.6±4.3 vs. 34.6±6.7; t=6.741, P〈0.001）, ALT（55.9±5.0 IU/L vs.82.0±5.7 IU/L; t=16.531,P〈0.001）, AST（53.4±2.4 IU/L vs. 80.0±3.1 IU/L; t=15.563, P〈0.001）, and TBIL（13.4±1.3 mmol/L vs. 15.7±0.82 mmol/L; t=10.326, P〈0.001） decreased as compared with those before the treatment. Conclusion The PE treatment can significantly improve liver function and inflammatory status in CSHB patients.

关 键 词：血浆置换 慢性重型乙型肝炎 炎性因子 

分 类 号：R318.14[医药卫生—生物医学工程]