自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究  

Efficacy of transhepatic artery autologous bone marrow stem cell transplantation in the treatment of patients with hepatitis B-induced acute-on-chronic liver failure

作　　者：宋玉 王芳 Song Yu;Wang Fang(Emergency ICU,Affiliated Hospital,Qinghai University Medical College,Xining 810000,Qinghai Province,China)

机构地区：[1]青海大学医学院附属医院急诊ICU,西宁市810000

出　　处：《实用肝脏病杂志》2020年第3期388-391,共4页Journal of Practical Hepatology

基　　金：青海省科技厅科研基金资助项目(编号:2018178)。

摘　　要：目的探讨采取自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者的疗效。方法2017年5月~2018年12月在我院肝肾内科就诊的94例HBV-ACLF患者,被随机分为对照组47例和观察组47例,在内科综合治疗的基础上分别给予血浆透析滤过(PDF)和PDF联合经肝动脉自体骨髓干细胞移植治疗。采用美国东部肿瘤协作组评分(ECOG)和终末期肝病模型(MELD)评分评价生活质量和肝功能状态。结果在治疗24周和48周时,观察组生存率分别为72.3%和53.2%,均显著高于对照组的48.9%和31.9%(P<0.05);在治疗24周末,34例观察组生存患者血清白蛋白(ALB)水平为(35.8±3.9)g/L,显著高于25例对照组【(32.3±3.5)g/L,P<0.05】;在治疗24周和48周时,观察组ECOG评分≥2级发生率为26.5%和12.0%,显著低于对照组56.5%和40.0%(P<0.05);在治疗48周时,观察组MELD评分为(9.7±1.3)分,显著低于对照组【(11.4±1.5)分,P<0.05】。结论采取PDF联合自体骨髓干细胞移植治疗HBV-ACLF患者可显著促进蛋白合成,降低病死率,提高ECOG评分。Objective The aim of this study was to explore the efficacy of transhepatic artery autologous bone marrow stem cell(BMSC)transplantation in the treatment of patients with hepatitis B-induced acute-on-chronic liver failure(HBV-ACLF).Methods 94 patients with HBV-ACLF were recruited in the Department of Hepatorenal Medicine of our hospital between May 2017 and December 2018,and were randomly divided into control(n=47)and observation group(n=47).All the patients were treated with comprehensive medical supporting treatment and plasma dialysis filtration(PDF),while those in the observation group were treated with transhepatic artery autologous BMSC transplantation at the base of PDF.All the patients were followed-up for 12 months.The Eastern cooperative oncology group(ECOG)scores and model for end-stage liver diseases(MELD)were evaluated.Results At the end of 24 week and 48 week treatment,the survival rates in the combination group were 72.3%and 53.2%,significantly higher than 48.9%and 31.9%(P<0.05)in the control;at the end of 24 week,serum albumin levels in 34 survival in the combination group was(35.8±3.9)g/L,much higher than【(32.3±3.5)g/L,P<0.05】in 25 survival in the control;at the end of 24 week and 48 week,the incidences of ECOG score greater than 2 were 26.5%and 12.0%,significantly lower than 56.5%and 40.0%(P<0.05)in the control;at the end of 48 week,the MELD score was(9.7±1.3),significantly lower than【(11.4±1.5),P<0.05】in the control.Conclusion The autologous bone marrow stem cell transplantation through hepatic artery at the base of comprehensive supporting measures might improve the albumin synthesis and raise the survival rates in patients with HBV-ACLF,which needs further investigation of its long-term efficacy.

关 键 词：慢加急性乙型肝炎肝衰竭 自体骨髓干细胞移植 血浆透析滤过 美国东部肿瘤协作组评分 终末期肝病模型 疗效 

分 类 号：R575.3[医药卫生—消化系统] R512.62[医药卫生—内科学]