血浆置换联合双重血浆吸附治疗提高慢加急性肝衰竭预后  

Plasma exchange combined with double plasma absorption therapy improve the prognosis of acute-onchronic liver failure

作　　者：钟珊[1] 王娜[1] 赵静[1] 张莉[1] 罗玲[1] 曾维琼[1] 石小枫[1] 王志毅[1] 蔡大川[1] 张大志[1] 周智[1] 胡鹏[1] Zhong Shan, Wang Na, Zhao Jing, Zhang Li, Luo Ling, Zeng Weiqun, Shi Xiaofeng, Wang Zhiyi, Cai Dachuan, Zhang Dazhi, Zhou Zhi, Hu Peng(Department of Infectious Diseases, the Second Affiliated Hospital, Chongqing Medical University; Viral Hepatitis Research Department, Chongqing Medical University; Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education and Department of lnfectious Disease, Chongqing Medical University, Chongqing 400010, China)

机构地区：[1]重庆医科大学附属第二医院感染科 重庆医科大学病毒性肝炎研究所 感染性疾病分子生物学教育部重点实验室,400010

出　　处：《中华肝脏病杂志》2018年第10期744-749,共6页Chinese Journal of Hepatology

摘　　要：目的比较血浆置换（PE）联合双重血浆吸附与单纯PE治疗慢加急性肝衰竭的疗效和安全性。方法回顾性分析2015年1月以来收治的经人工肝治疗的慢加急性肝衰竭患者251例。比较不同模式治疗前后患者症状、体征、实验室检查以及并发症的变化情况，并追踪近期疗效。据资料不同用t检验、Pearsonz。检验或者Fisher确切概率法进行统计学分析。结果早期肝衰竭，低置换PE联合双重血浆分子吸附系统（DPMAs）（83.7％）和等量PE联合DPMAS治疗有效率（84．0％和82．1％）明显优于单纯的足量PE（55．6％）垆〈0．05）。中晚期肝衰竭，各组治疗有效率差异无统计学意义（P〉0．05）。联合治疗组的胆红素下降率、胆汁酸下降率均明显优于PE组（P〈0．05）。低置换量PE联合DPMAS（LPE＋DPMAS）组，先PE后DPMAS组的凝血酶原活动度改善率，白蛋白改善率均明显低于PE组（P〈0．05）。先DPMAS后PE组凝血酶原活动度改善率和白蛋白改善率与PE组差异无统计学意义。各组不良反应发生差异无统计学意义。结论较单纯PE而言，PE联合DPMAS既能提高早期肝衰竭治疗有效率，还能减少血浆用量。先行DPMAs治疗后行PE治疗，能改善DPMAS对凝血功能和白蛋白水平的不良影响。Objective To compare the efficacy and safety of plasma exchange （PE） combined with double plasma absorption and simple PE in the treatment of acute-on-chronic liver failure. Methods We retrospectively analyzed 251 cases of acute-on-chronic liver failure treated with artificial liver treatment since January 2015. Changes in clinical manifestations, laboratory tests, and complications of the patients before and after different modes of treatment were compared and short-term efficacy was tracked. In accordance with different data, t-test, Pearson＇s chi-squared test and Fisher＇s exact test were used for statistical analysis. Results The effectiveness of low-volume PE combined with double plasma molecular adsorption system （DPMAS） and equal amount of PE combined with DPMAS was significantly better than simple PE （83.7%, 84.05% and 82.15 vs 55.6%, P 〈 0.05） in early stage of liver failure. In late-stage of liver failure, there was no significant difference in the treatment efficiency of each group （P 〉 0.05）. Bilirubin and bile acid levelswere significantly decreased in combined treatment groups than that to simple PE group （P 〈 0.05）. PTA and albumin improvement rate of DPMAS PE groups were significantly lower than that of simple PE group （P 〈 0.05）. There was no statistical difference in adverse reactions between each group. Conclusion PE combined with DPMAS improves the treatment efficiency of early hepatic failure and decrease dosage of plasma when compared with simple PE. A beforehand DPMAS treatment after PE treatment can improve the adverse effects of DPMAS on blood coagulation function and albumin levels.

关 键 词：肝衰竭 肝 人工 血浆置换 双重血浆吸附 

分 类 号：R575.3[医药卫生—消化系统]