双重血浆分子吸附系统治疗乙肝慢加急肝衰竭患者疗效及其对T淋巴细胞亚型的影响  

The influence of DPMAS on T cell subtype of peripheral blood in patients with HBV associated acute and chronic liver failure

作　　者：吴蓓 朱丽 段萌 李守娟 王磊 王丽 

机构地区：[1]成都市公共卫生临床医疗中心传染科,610000

出　　处：《疑难病杂志》2016年第6期584-587,591,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察双重血浆分子吸附系统(DPMAS)治疗乙肝慢加急肝衰竭(AoCLF)患者的疗效及对外周血T淋巴细胞亚型的影响。方法 2013年1月一2015年1月成都市公共卫生临床医疗中心传染科治疗HBV-AoCLF患者42例,根据是否接受DPMAS治疗分为DPMAS组(n=10)、血浆置换组(PE组,n=16)和对照组(n=16)。比较治疗前和治疗后1周外周血T淋巴细胞指标改变与临床预后的关系。结果 DPMAS组28天病死率明显低于对照组(10.0%vs.37.5%,P<0.05)。治疗后,DPMAS组患者CD4^+和CD4^+/CD8^+水平明显上升(P<0.05),而CD8^+水平明显下降(P<0.05),且明显优于PE组及对照组(P<0.05)。生存亚组患者CD4^+和CD4^+/CD8^+水平明显上升,CD8^+水平明显下降(P<0.05),而死亡亚组上述指标均无显著变化(P>0.05)。DPMAS治疗与AoCLF患者28天死亡事件存在负相关(r=-0.683,P=0.01),与△CD4^+、△CD8^+和△CD4^+/CD8^+呈正相关(r=0.712,P=0.02;r=0.650,P=0.02;r=0.598,P=0.04)。DPMAS治疗后30天死亡风险明显降低(P<0.05)。结论 DPMAS治疗可以通过改善HBV相关AoCFL患者血清T细胞亚型分布,进而提高生存率。Objective To evaluate the influence of DPMAS on T cell subtype of peripheral blood in patients with HBV／ associated acute and chronic liver failure（HBV AoCLF）.Methods From 2013 January to 2015 January,42 cases of HBV AoCLF patients in Department of Infectious Diseases,Chengdu City Public Health Clinical Medical Center were enrolled,according to whether or not accept the DPMAS treatment,they were divided into DPMAS group（n = 10）,the plasma exchange group（PE group,n =16） and control group（n = 16）.Compared the relationship between the changes ol peripheral blood T lymphocyte indexes and the clinical outcome 1 week alter treatment and before treatment.Results The 28 days mortality rale in DPMAS group was lower than that in control group（10.0%vs.37.5%,P〈0.05）.After treatment,the levels of CD4-＋ and CD4-＋/ CD8 -＋ were increased（P〈0.05）,while the level of CD8-＋ was decreased（P〈0.05）.Correlation analysis showed that DPMAS was negatively associated with 28 day mortality rate（r =-0.683,P =0.01） and positively related with CD4-＋,CD8.＋ and CD4-＋ / CD8-＋（r =0.712,P =0.02;r =0.650,P =0.02;r =0.598,P =0.04）.Cox analysis showed that DPMAS reduced mortality rate decreased on 30 th day（P〈0.05）.Conclusion The DPMAS treatment can improve the survival rate by improving the distribution of T cell subsets in the serum ol patients with HBV related AoCFL.

关 键 词：双重血浆分子吸附系统 乙肝慢加急肝衰竭 外周血T淋巴细胞亚型 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]