不同人工肝方法治疗亚急性重型肝炎的疗效对比研究  

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

作　　者：叶晓玲[1] 程书权 杨景毅 冼永超 唐振祥 

机构地区：[1]江西省九江市第一人民医院肝病科,332000 [2]桂林市第三人民医院肝病科,广西桂林541002 [3]桂林市妇女儿童医院,广西桂林541001

出　　处：《重庆医学》2015年第27期3775-3778,共4页Chongqing medicine

基　　金：广西壮族自治区卫生厅立项课题(Z2013438);桂林市科技局立项课题(20140120-9-1)

摘　　要：目的观察血浆置换(PE)、血浆置换联合血浆胆红素吸附(PE+PBA)与血浆置换联合双重血浆分子吸附系统(PE+DPMAS)治疗亚急性重型肝炎的临床疗效,探讨重型肝炎的最佳人工肝治疗方案。方法统计同期收治的应用人工肝治疗的140例乙型肝炎病毒(HBV)感染亚急性重型肝炎病例,按照PE、PE+PBA、PE+DPMAS分为3组,对比3组患者治疗前、后临床症状及血常规、电解质和主要生化指标的变化。结果 PE+DPMAS组治疗有效率70.8%,稍高于PE、PE+PBA两组(60.9%、67.4%),但差异无统计学意义(P>0.05);治疗前、后3组患者血清总胆红素(TBIL)、丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、球蛋白(GLB)等生化指标较治疗前明显下降(P<0.001),治疗后PE组前清蛋白(PA)较治疗前升高,PE+PBA组和PE+DPMAS组均较治疗前降低,差异有统计学意义(P<0.05);PE组凝血酶原时间(PT)较治疗前下降(P<0.05),PE+PBA组PT较治疗前下降,PE+DPMAS组PT较治疗前稍升高,但差异无统计学意义(P>0.05);PE组血清K+、Cl-较治疗前明显降低(P<0.001);PE组治疗前、后血清Na+差异无统计学意义(P>0.05),PE+PBA、PE+DPMAS组血清Na+较治疗前降低(P<0.001);3组血清Ca2+均较治疗前降低,差异有统计学意义(P<0.001);血常规WBC、Hb、PLT治疗前、后比较差异有统计学意义(P<0.05)。结论 PE单独应用和联合PBA或DPMAS,均可有效改善亚急性重型肝炎患者的肝功能,提高救治率;联合治疗可节省血浆用量2/3,方便更多患者使用;PE联合DPMAS对患者血清Cl-、Ca2+及Hb下降的影响幅度最小,具有更佳的临床应用价值。Objective To observe the clinical efficacy of plasma exchange（PE）,PE combined with plasma bilirubin absorption（PE＋PBA）,and PE combined with double plasma molecule absorption system（PE＋DPMAS）,to investigate the best treatment options for the patients of hepatitis B-associated subacute severe.Methods Totally 140 patients who had hepatitis B-associated were randomly divided into a PE group,a PE＋PBA group,and a PE＋DPMAS group.The dinical symptoms and blood rontine,electrolytc and the main biochemical indexes were recorded both before and after treatment and compared among the three groups.Results The total effective rate was higher in the PE ＋DPMAS group than in the PE group and PE＋PBA group,which were70.8%,60.9%,67.4%respectively,but there was no significant difference（P〉0.05）.compared with before treatment,serum total bilirubin（TBIL）,alanine aminotransferase（ALT）,aspartic acid amino shift enzyme（AST）,valley aminoacyl transfer peptidase（GGT）,alkaline phosphatase（ALP）,globulin（GLB）and other biochemical indexes decreased significantly after treatment in 3groups（P〈0.001）.PA was increased in the PE group and decreased in the PE＋PBA and PE＋DPMAS group after treatment,the differences were significant（P〈0.05）.After treatment,PT was shortened in the PE group,the differences were significant（P〈0.05）,but there were no significant difference between the PE＋PBA and PE＋DPMAS groups（P〉0.05）.Serum K^＋and Cl^-was obviously declined after treatment in the PE group,there was significant difference（P〈0.001）.Serum Na^＋ was obviously declined after treatment between the PE＋PBA and PE＋DPMAS groups（P〈0.001）,but the difference was no significant in the PE groups.Serum Ca^2＋was significantly decreased in the three groups of patients after treatment（P〈0.001）.WBC,Hb and PLT were significantly statistical difference after treatment（P〈0.05）.Conclusion The three groups also can improve liver function and the treatment rate for

关 键 词：肝 人工 亚急性重型肝炎 血浆置换 血浆胆红素吸附 双重血浆分子吸附系统 

分 类 号：R512.62[医药卫生—内科学]