CRRT联合PE治疗慢加急性乙型肝炎肝衰竭并发急性肾损伤患者疗效研究  

Decreased 90-day mortality in patients with hepatitis B-induced acute-on-chronic liver failure and acute kidney injury by continuous renal replacement therapy and plasma exchange treatment

作　　者：关万涛 康福新[2] 林维 林宏云 黎仕焕 Guan Wantao;Kang Fuxin;Lin Wei(Intensive Care Unit,Central Hospital,Sanya 572000,Hainan Province,China)

机构地区：[1]三亚中心医院重症医学科,海南省三亚市572000 [2]海南医学院第二附属医院重症医学科 [3]海南医学院第二附属医院骨科 [4]海南医学院第二附属医院麻醉科

出　　处：《实用肝脏病杂志》2020年第6期833-836,共4页Journal of Practical Hepatology

基　　金：海南省三亚市科技发展重点项目(编号:L1412);海南省三亚市科技创新课题(编号:2014YW16)。

摘　　要：目的研究采用持续性肾脏替代治疗(CRRT)联合血浆置换(PE)治疗慢加急性乙型肝炎肝衰竭并发急性肾损伤(AKI)患者的临床疗效。方法2016年10月~2019年11月于我院重症医学科救治的65例慢加急性乙型肝炎肝衰竭并发AKI患者,其中35例接受CRRT联合PE治疗,30例接受PE治疗。计算估算的肾小球滤过率(eGFR)、肌酐清除率(Ccr)和联合钠的终末期肝病模型(MELD-Na)。结果联合组患者90 d生存率为54.3%,显著高于PE组的23.3%(P<0.05);在治疗后90 d,联合组19例生产者血清总胆红素水平为(28.8±11.1)μmol/L,显著低于PE治疗组7例生存者的[(39.4±13.0)μmol/L,P<0.05];在治疗后28 d,联合组25例生存者eGFR水平为(79.4±24.7)mL/min/1.73 m^2,显著高于PE组16例生存者的[(65.75±16.1)mL/min/1.73 m^2,P<0.05],Ccr水平为(77.3±25.7)mL/min,显著高于PE组的[(63.4±20.1)mL/min,P<0.05],MELD-Na水平为(22.4±4.5)分,显著低于PE组的[(29.5±4.1)%,P<0.05],在治疗90 d,两组上述指标差异无统计学意义(P>0.05)。结论联合采用CRRT和PE治疗慢加急性乙型肝炎肝衰竭并发AKI患者可提示短期生存率,可能与保护肝肾功能有关,值得临床进一步研究。Objective The purpose of this study was to investigate the efficacy of continuous renal replacement therapy(CRRT)and plasma exchange(PE)combination in the treatment of patients with acute-on-chronic hepatitis B liver failure(ACLF)complicated by acute kidney injury(AKI).Methods 65 ACLF patients caused by hepatitis B viral infection and AKI were treated in ICU of our hospital between October 2016 and November 2019,and 35 cases received CRRT and PE combination and 30 received PE alone at base of conventional supporting management.The estimated glomerular filtration rate(eGFR),creatinine clearance rate(Ccr)and model for end-stage liver disease-Na(MELD-Na)were calculated.Results The survival rate in combination-treated group at day 90 was 54.3%,significantly higher than 23.3%in the PE-treated group(P<0.05);at the end of 90 day treatment,serum bilirubin level in 19 survivals in CRRT and PE-treated group was(28.8±11.1)μmol/L,much lower than[(39.4±13.0)μmol/L,P<0.05]in 7 patients in PE-treated group;at the end of day 28,the eGFR in 25 survivals in CRRT and PE combination-treated group was(79.4±24.7)mL/min/1.73 m^2,significantly higher than(65.75±16.1)mL/min/1.73 m^2,P<0.05],the Ccr was(77.3±25.7)mL/min,much higher than[(63.4±20.1)mL/min,P<0.05],and the MELD-Na score was(22.4±4.5),significantly lower than[(29.5±4.1)%,P<0.05]in 16 survivals in PE-treated group,while the three parameters above mentioned in the survivals of the two groups at day 90 were not significantly different(P>0.05).Conclusion The application of CRRT and PE in the treatment of patients with ACLF caused byhepatitis B viral infection and complicated by AKI could reduce the short-term mortality,which might protect the liver and kidney functions and warrants further multi-central clinical trials.

关 键 词：慢加急性肝衰竭 乙型肝炎 急性肾损伤 持续性肾脏替代治疗 血浆置换 治疗 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学] R692