半量血浆置换联合双重血浆分子吸附系统对慢加急性肝衰竭患者炎性反应、免疫功能及肝功能的影响  

The effect of half volume plasma exchange combined with double plasma molecular adsorption system on inflammatory response,immune function and liver function in patients with chronic acute liver failure

作　　者：秦浩[1] 王洋 魏金刚 高朋彬[4] 吴凤影[1] 任飞 Qin Hao;Wang Yang;Wei Jingang;Gao Pengbin;Wu Fengying;Ren Fei(Department of Critical Care Medicine, The Fifth Hospital of Shijiazhuang, Shijiazhuang 050000, China)

机构地区：[1]石家庄市第五医院重症医学科,050000 [2]石家庄市第五医院感染一科,050000 [3]石家庄市第五医院外科,050000 [4]石家庄市第五医院感染三科,050000

出　　处：《疑难病杂志》2020年第5期485-489,509,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：石家庄市科学技术研究与发展指导计划项目(171461873)。

摘　　要：目的观察半量血浆置换(LPE)联合双重血浆分子吸附系统(DPMAS)对慢加急性肝衰竭(ACLF)患者炎性因子、T淋巴细胞亚群及肝功能的影响。方法选择2017年1月—2018年12月石家庄市第五医院重症医学科收治ACLF患者129例作为研究对象,采用随机数字表法分为PE组、PE+DPMAS组和LPE+DPMAS组,每组43例。PE组给予单纯PE治疗,PE+DPMAS组给予全量PE(2500~3000 ml)联合DPMAS治疗,LPE+DPMAS组给予半量PE(1200~1500 ml)联合DPMAS治疗,治疗7 d,分析各组炎性因子、T淋巴细胞亚群及肝功能变化,并评价短期疗效。结果3组均无患者死亡。治疗总有效率比较,PE+DPMAS组、LPE+DPMAS组高于PE组(χ^2/P=7.527/0.000);治疗后PE+DPMAS组、LPE+DPMAS组IL-10、TGF-β高于PE组(F/P=18.241/0.000、41.535/0.000),IL-6、TNF-α、CRP低于PE组(F/P=39.267/0.000、64.026/0.000、58.570/0.000);PE+DPMAS组、LPE+DPMAS组CD^4+、CD^4+/CD^8+高于PE组(F/P=6.297/0.002、7.502/0.001),CD^8+低于PE组(F/P=4.873/0.009);PE+DPMAS组、LPE+DPMAS组TBil、DBil、ALT低于PE组(F/P=14.168/0.000、31.911/0.000、21.816/0.000),PTA高于PE组(F/P=16.138/0.000);治疗后PE+DPMAS组、LPE+DPMAS组上述各指标比较差异无统计学意义(P>0.05)。3组不良反应发生率比较差异无统计学意义(P>0.05)。结论PE联合DPMAS治疗ACLF患者效果优于单独PE治疗,能更好地抑制炎性反应,提高免疫能力,促进肝功能恢复;且半量PE联合DPMAS与全量PE联合DPMAS治疗效果相当。Objective To observe the effects of LPE combined with DPMAS on inflammatory factors,T lymphocyte subsets and liver function in patients with chronic acute liver failure(ACLF).Methods From January 2017 to December 2018,129 patients with ACLF admitted to the Department of Critical Medicine of Shijiazhuang Fifth Hospital were selected as the study objects.They were randomly divided into PE group,PE+DPMAS group and LPE+DPMAS group,with 43 cases in each group.PE group was treated with PE alone,PE+DPMAS group with total PE(2500~3000 ml)combined with DPMAS,LPE+DPMAS group with half PE(1200~1500 ml)combined with DPMAS for 7 days.The changes of inflammatory factors,T lymphocyte subsets and liver function in each group were analyzed and the short-term effect was evaluated.Results The total effective rate of PE+DPMAS group and LPE+DPMAS group was higher than that of PE group(χ^2/P=7.527/0.000).After treatment,IL-10 and TGF-βin PE+DPMAS group and LPE+DPMAS group were higher than those in PE group(F/P=18.241/0.000,41.535/0.000),IL-6,TNF-αand CRP were lower than those in PE group(F/P=39.267/0.000,64.026/0.000,58.570/0.000).CD^4+,CD^4+/CD^8+in PE+DPMAS group and LPE+DPMAS group were higher than those in PE group(F/P=6.297/0.002,7.502/0.001),and CD^8+was lower than those in PE group(F/P=4.873/0.009).TBIL,DBIL and ALT in PE+DPMAS group and LPE+DPMAS group were lower than those in PE group(F/P=14.168/0.000,31.911/0.000,21.816/0.000),and PTA was higher than those in PE group(F/P=16.138/0.000).After treatment,there was no significant difference between PE+DPMAS group and LPE+DPMAS group(P>0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion PE combined with DPMAS is better than PE alone in the treatment of ACLF,which can better inhibit the inflammatory response,improve the immune capacity,and promote the recovery of liver function;and the treatment effect of half PE combined with DPMAS is equivalent to that of full PE combined with DPMAS.

关 键 词：慢加急性肝衰竭 半量血浆置换 双重血浆分子吸附系统 炎性因子 T淋巴细胞亚群 肝功能 

分 类 号：R57[医药卫生—消化系统]