单纯血浆置换与双血浆分子吸附系统联合半剂量血浆置换治疗重型肝炎患者疗效的Meta分析  

Efficacy of simple plasma exchange and double plasma molecular absorption system combined with half dose plasma exchange in the treatment of severe hepatitis:a Meta-analysis

作　　者：钟韵 赵树山[2] 黄燕[1] 黄泽炳[1] 范学工[1] ZHONG Yun;ZHAO Shu-shan;HUANG Yan;HUANG Ze-bing;FAN Xue-gong(Department of Infectious Diseases,Key Laboratory of Viral Hepatitis of Hunan Province,China,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Orthopedics,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院感染病科/病毒性肝炎湖南省重点实验室,湖南长沙410008 [2]中南大学湘雅医院骨科,湖南长沙410008

出　　处：《中国感染控制杂志》2020年第5期417-425,共9页Chinese Journal of Infection Control

基　　金：国家自然科学基金项目(81700561)。

摘　　要：目的系统评价单纯血浆置换(PE)与双血浆分子吸附系统(DPMAS)联合半剂量PE治疗重型肝炎的疗效。方法计算机检索PubMed、Embase、The Cochrane Library、CNKI、万方数据库,搜集有关PE与DPMAS+PE治疗重型肝炎的随机对照临床研究文献,应用STATA/SE 15.1软件对符合纳入的临床研究进行Meta分析。结果共纳入8篇文献,819例患者,其中394例患者采用单纯PE治疗,425例患者采用DPMAS+PE联合治疗。PE、DPMAS+PE治疗在对血总胆红素、直接胆红素、谷氨酸氨基转移酶、白细胞、总蛋白、球蛋白、凝血酶原活动度、氯离子、钠离子的影响方面,两者差异均无统计学意义(均P>0.05);PE+DPMAS组治疗后的血红蛋白、血小板高于PE组,差异有统计学意义(分别为SMD=-0.33,95%CI:-0.51^-0.15,P<0.001;SMD=-0.27,95%CI:-0.45^-0.09),P=0.003);PE+DPMAS组治疗后的钾离子高于PE组(SMD=-0.29,95%CI:-0.49^-0.10,P=0.003)。结论PE、DPMAS+PE均能有效改善重型肝炎患者病情,且PE+DPMAS可有效减少血浆用量,对钾离子、血红蛋白和血小板下降的影响更小。有条件尤其是血浆不够的情况下,DPMAS+PE是治疗重型肝炎患者较好的选择。Objective To evaluate the efficacy of simple plasma exchange(PE)and double plasma molecular absorption system(DPMAS)combined with half dose PE in the treatment of severe hepatitis.Methods PubMed,Embase,the Cochrane Library,CNKI and Wanfang Data were searched by computer,literatures on randomized controlled trials about PE and DPMAS+PE in the treatment of severe hepatitis were collected,Meta-analysis on clinical research conforming to the inclusion was conducted by Stata/SE 15.1 software.Results A total of 8 literatures,819 patients were included in analysis,394 of patients were treated with simple PE and 425 were treated with DPMAS+PE.There were no significant differences in the effect of PE as well as DPMAS+PE treatment on total bilirubin,direct bilirubin,alanine-aminotransferase(ALT),white blood cells,total protein,globulin,prothrombin activity,chlorine ion and sodium ion(all P>0.05);after treatment,hemoglobin and platelet in PE+DPMAS group were higher than those in PE group,difference was statistically significant(SMD=-0.33,95%CI:-0.51—-0.15,P<0.001;SMD=-0.27,95%CI:-0.45—-0.09,P=0.003,respectively);potassium ion in PE+DPMAS group was higher than that in PE group(SMD=-0.29,95%CI:-0.49—-0.10,P=0.003).Conclusion Both PE and DPMAS+PE can effectively improve the condition of patients with severe hepatitis,PE+DPMAS can effectively reduce the amount of plasma used,and has less effect on the decrease of potassium ion,hemoglobin and platelet.Therefore,DPMAS+PE is a better choice for treating patients with severe hepatitis,especially in the case of insufficient plasma.

关 键 词：血浆置换 双血浆分子吸附系统 肝衰竭 重型肝炎 人工肝 联合治疗 

分 类 号：R575.3[医药卫生—消化系统]