胆红素吸附治疗慢性重型乙型肝炎的效果及安全性评估  

Effect and safety of bilirubin serum adsorption in treatment of patients with chronic severe hepatitis B

作　　者：汪清海[1] 罗开忠[2] 田沂[2] 

机构地区：[1]常德市第一人民医院感染科,湖南常德415003 [2]中南大学湘雅二医院肝病研究中心,长沙410011

出　　处：《临床肝胆病杂志》2016年第7期1296-1299,共4页Journal of Clinical Hepatology

基　　金：湖南省卫生厅科研基金资助课题(B2006-052)

摘　　要：目的评估慢性重型乙型肝炎患者胆红素吸附的疗效及安全性。方法前瞻性研究2014年1月1日-2015年12月31日于中南大学湘雅二医院住院的凝血酶原活动度(PTA)>25%的慢性重型乙型肝炎患者40例,均予胆红素吸附治疗。收集治疗前后以及治疗后一周的患者血常规[白细胞(WBC)、红细胞、血红蛋白、血小板],凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)],肝功能[TBil、DBil、总胆汁酸(TBA)、白蛋白(Alb)、球蛋白(Glb)]、电解质(K^+、Na^+、Cl^-、Ca^(2+)),治疗前后和治疗过程中观察记录患者血压、呼吸、心率、氧饱和度,观察患者有无畏寒发热、头晕、胸闷、腹痛等症状。计量资料组间比较采用t检验。结果患者对治疗的耐受性均较好,治疗结束后患者临床症状好转。TBil、DBil、TBA均下降,Alb、Glb、Fib亦有轻度下降,而PT、APTT则较治疗前延长,差异均具统计学意义(t值分别为21.254、22.395、7.821、6.986、7.580、9.852、10.705、5.528,P值均<0.001)。治疗后Ca^(2+)较治疗前降低,WBC较治疗前升高,差异均具统计学意义(t值分别为6.924、9.852,P值均<0.001)。在随访1周时,Alb、Glb、Fib、PT、APTT、Ca^(2+)、WBC均恢复至治疗前水平,TBil、DBil、TBA较治疗后有不同程度升高,但比治疗前低。40例患者中有12例(30%)发生不良反应,其中3例(7.5%)畏寒(或寒颤)、3例(7.5%)血压下降、2例(5.0%)心率下降、1例(2.5%)头晕、1例(2.5%)恶心呕吐、1例(2.5%)腹痛、1例(2.5%)出冷汗。结论胆红素吸附治疗对PTA>25%的慢性重型乙型肝炎患者安全有效,对患者的凝血功能、血清Ca^(2+)、WBC有短暂影响。Objective To investigate the effect and safety of bilirubin serum adsorption（ BSA） in the treatment of patients with chronic severe hepatitis B. Methods A prospective study was performed for 40 patients with chronic severe hepatitis B[prothrombin activity（ PTA） 25%] who were hospitalized in The Second Xiangya Hospital of Central South University from January 1,2014 to December 31,2015,and all the patients were given BSA. The results of routine blood test [white blood cell（ WBC） count,red blood cell（ RBC） count,hemoglobin（ Hb）,and platelet（ PLT） count],coagulation function [prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,and fibrinogen（ Fib） ],liver function [total bilirubin（ TBil）,direct bilirubin（ DBil）,total bile acid（ TBA）,albumin（ Alb）,and globulin（ Glb） ],and electrolytes（ K^＋,Na^＋,Cl^-,and Ca^2＋） were collected before treatment and at 1 week after treatment. Blood pressure,breath,heart rate,and oxygen saturation were observed and recorded before,during,and after treatment,and the presence or absence of symptoms such as fear of cold,pyrexia,dizziness,chest distress,and abdominal pain was observed. The t- test was used for comparison of continuous data between groups. Results All the patients had good tolerance of the treatment,and clinical symptoms were improved after treatment. TBil,DBil,and TBA showed significant reductions,Alb,Glb,and Fib showed slight reductions,and PT and APTT were significantly prolonged（ t = 21. 254,22. 395,7. 821,6. 986,7. 580,9. 852,10. 705,and 5. 528,all P〈0. 001）. After treatment,Ca^2＋level was significantly reduced and WBC count increased significantly（ t = 6. 924 and 9. 852,both P〈0. 001）. At the 1- week follow- up,Alb,Glb,Fib,PT,APTT,Ca^2＋level,and WBC count almost returned to the same levels before treatment,and TBil,DBil,and TBA showed varying degrees of increases compared with the values after treatment,but remained lower than the values before treatment. Of all the40 patient

关 键 词：肝炎 乙型 慢性 胆红素 治疗 

分 类 号：R512.62[医药卫生—内科学]