血浆置换联合血液滤过治疗抗结核药物所致亚急性肝衰竭的效果分析  

Clinical effect of plasma exchange combined with hemofiltration in patients with subacute liver failure induced by antitubercular agents

作　　者：侯环荣[1] 尚佳[1] 康谊[1] 李玉魁[1] 曾艳丽[1] 丁岗强[1] 毛重山[1] 肖二辉[1] 

机构地区：[1]河南省人民医院感染性疾病科,郑州450003

出　　处：《临床肝胆病杂志》2016年第2期342-346,共5页Journal of Clinical Hepatology

基　　金：河南省医学科技攻关项目(201303120);国家临床重点专科建设项目

摘　　要：目的探讨血浆置换(PE)联合血液滤过(HF)治疗抗结核药物所致亚急性肝衰竭(SALF)的临床疗效。方法收集2009年7月-2015年1月于河南省人民医院就诊的抗结核药物所致SALF患者58例,按治疗方法不同将其分为PE治疗组(n=27)和PE联合HF治疗组(n=31)。比较治疗前后两组患者的临床症状及体征、肝功能、肾功能、电解质和凝血功能的变化,观察两组患者不良反应发生情况及半年存活率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果 PE治疗组和PE联合HF治疗组经治疗后,ALT、AST、TBil、GGT、ALP水平较治疗前均降低,凝血酶原活动度(PTA)均升高,治疗前后差异均有统计学意义(t值分别为2.871、2.986、2.905、2.063、4.028、-2.591;2.940、2.935、2.940、2.918、4.981、-2.933,P值均<0.05);两治疗组间ALT、AST、TBil、GGT、ALP、PTA变化的差值比较差异均有统计学意义(t值分别为-2.891、-2.784、-2.194、-3.014、-0.294、-3.907,P值均<0.05)。PE治疗组纠正高尿素(UREA)、高肌酐(Cr)、低钾血症、低钠血症、低氯血症、低钙血症有效率分别为80.00%、60.00%、81.82%、78.57%、88.89%、75.00%;PE联合HF治疗组纠正高UREA、高Cr、低钾血症、低钠血症、低氯血症、低钙血症有效率分别为85.71%、87.50%、85.71%、92.31%、92.31%、86.67%,两组间比较差异均有统计学意义(χ2值分别为9.603、11.302、9.543、13.987、9.493、9.502,P值均<0.05);PE治疗组疗效总有效率为88.89%,平均住院时间为36.36 d;PE联合HF治疗组总有效率为96.77%,平均住院时间为26.03 d;不良反应发生率分别为5.06%、7.06%。结论 PE联合HF治疗抗结核药物所致SALF与单纯行PE治疗相比,能显著改善患者临床症状体征、改善肝功能、纠正电解质紊乱、改善肾功能、提高总有效率、降低平均住院时间,且不良反应发生率低,是一种安全有效的治疗方法。Objective To investigate the clinical effect of plasma exchange （PE） combined with hemnfihration （HF） in the treatment of subacute liver failure （SALF） induced by antitubercular agents. Methods A total of 58 patients with SALF induced by antitubereular a- gents who visited Henan Provincial People＇s Hospital from July 2009 to January 2015 were collected and divided into PE treatment group （27 patients） and PE -HF combined treatment group （31 patients） according to different therapeutic methods. The changes in clinical symptoms and signs, liver function, renal function, electrolytes, and coagulation function after treatment were investigated and compared between the two groups, and the incidence of adverse events and 6 -month survival rate were observed in both groups. The t -test was applied for comparison of continuous data between groups, and the chi - square test was applied for comparison of categorical data between groups. Results After treat- ment, both PE treatment group and PE - HF combined treatment group had significant reductions in the levels of ALT, AST, TBil, GGT, and ALP, as well as a significant increase in prothrombin activity （PTA） （t = 2. 871, 2. 986, 2. 905, 2. 063, 4. 028, - 2. 591, 2. 940, 2. 935, 2. 940, 2.918, 4. 981, and - 2. 933, all P 〈 0. 05 ） ; the PE - HF combined treatment group had significantly greater reductions in ALT, AST, TBil, GGT, and ALP and a significantly greater increase in PTA, as compared with the PE treatment group （t = -2.891, 2. 784, - 2.194, - 3. 014, - 0. 294, and - 3. 907, all P 〈 0.05）. In the PE treatment group, the response rates to correct high urea （ U- REA）, high creatinine （ Cr）, hypokalemia, hyponatremia, hypochloridemia, and hypocalcemia were 80.00%, 60.00%, 81.82%, 78. 57%, 88.89%, and 75.00%, respectively; in the PE - HF combined treatment group, these response rates were 85.71%, 87.50%, 85.71%, 92.31%, 92.31%, and 86.67%, respectively; there were significant differences in these response rates between the t

关 键 词：肝功能衰竭 血浆置换 血液滤过 对比研究 

分 类 号：R575.3[医药卫生—消化系统]