血浆置换双重分子吸附系统治疗重型乙型肝炎的价值  

The value of plasma exchange dual molecular adsorption system in the treatment of severe hepatitis B

作　　者：董芳[1] 刘龙梅 杨慧 李雪[1] 吕荣德 Dong Fang;Liu Longmei;Yang Hui;Li Xue;Lv Rongde(Department of Infectious Diseases,the 901st Hospital of the People's Liberation Army Joint Service Support Force,Hefei,Anhui 230000,China)

机构地区：[1]中国人民解放军联勤保障部队第901医院感染科,安徽合肥230000

出　　处：《现代科学仪器》2021年第2期170-175,共6页Modern Scientific Instruments

摘　　要：目的:观察血浆置换(PE)联合双重血浆分子吸附系统(DPMAS)在重型乙型肝炎治疗中的应用价值。方法:回顾性分析2015年1月~2019年12月169例重型乙肝患者临床治疗,根据人工肝模式不同,分为单纯PE组(单纯PE治疗)与联合组(先行DPMAS治疗,再行低置换量PE治疗),经1:1倾向性匹配评分,得到2组各50例患者。治疗3次后,比较2组治疗前后肝功能指标[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、血浆白蛋白(ALB)、总胆汁酸(TBA)]、凝血功能指标[凝血酶原时间(PT)、凝血酶原活动度(PTA)、血小板(PLT)]、外周血T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)比值)及不良反应发生率。结果:治疗后,2组ALT、TBIL、ALB、TBA水平均较治疗前下降(P<0.05),且联合组ALT、TBIL、TBA水平明显低于单纯PE组(P<0.05);2组PT水平均较治疗前下降(P<0.05),PTA水平较治疗前上升(P<0.05),但PLT水平与治疗前比较差异无统计学意义(P>0.05),且2组PT、PTA、PLT水平比较差异均无统计学意义(P>0.05);2组外周血CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)比值均较治疗前上升(P<0.05),CD_(8)^(+)较治疗前下降(P<0.05),且联合组外周血CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)比值明显高于单纯PE组(P<0.05),CD_(8)^(+)明显低于单纯PE组(P<0.05)。联合组不良反应总发生率14.67%,明显低于单纯PE组的27.33%(P<0.05)。结论:相比单纯PE治疗,PE联合DPMAS治疗重型乙型肝炎患者,可更好改善患者肝功能及T细胞亚型分布,且不良反应少。Objective To observe the application value of plasma exchange(PE)combined with dual plasma molecular adsorption system(DPMAS)in the treatment of severe hepatitis B.Methods The clinical data of 169 patients with severe hepatitis B from January 2015 to December 2019 was retrospectively analyzed.According to the different artificial liver models,they were divided into simple PE group(only PE treatment)and combined group(DPMAS treatment first,followed by PE with low replacement volume).After a 1:1 propensity matching score,50 patients in each group were obtained.After 3 times of treatment,the liver function indexes[alanine aminotransferase(ALT),total bilirubin(TBIL),plasma albumin(ALB),total bile acid(TBA)],coagulation function indexes[prothrombin time(PT),prothrombin activity(PTA),platelet(PLT)],peripheral blood T lymphocyte subsets(CD_(4)^(+),CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+)ratio)and incidence rates of adverse reactions were compared between the two groups before and after treatment.Results After treatment,the levels of ALT,TBIL,ALB and TBA in the two groups were lower than those before treatment(P<0.05),and the levels of ALT,TBIL and TBA in combined group were significantly lower than those in simple PE group(P<0.05).The PT level in the two groups was lower than that before treatment(P<0.05)while the PTA level was higher than that before treatment(P<0.05),but there was no significant difference in the PLT level compared with that before treatment(P>0.05),and there were no statistically significant differences in the levels of PT,PTA and PLT between the two groups(P>0.05).The peripheral blood CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)ratio in the two groups were higher than those before treatment(P<0.05)while CD_(8)^(+)was lower than that before treatment(P<0.05),and the peripheral blood CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)ratio in combined group were significantly higher than those in simple PE group(P<0.05)while CD_(8)^(+)was significantly lower than that in simple PE group(P<0.05).The total incidence rate of adverse

关 键 词：重型乙型肝炎 人工肝 血浆置换 双重血浆吸附 

分 类 号：R51[医药卫生—内科学]