PE结合DPMAS对肝硬化并发慢加急性肝衰竭患者生存状况的影响  

Effect of PE combined with DPMAS on survival of patients with liver cirrhosis complicated with chronic and acute liver failure

作　　者：秦维 祝素平[1] 郑艳丽[1] 霍玉玲 王丹 QIN Wei;ZHU Su-ping;ZHENG Yan-li;HUO Yu-ling;WANG Dan(Fourth Liver Department of Baoding Infectious Diseases Hospital,071000,China)

机构地区：[1]保定市传染病医院肝四科,071000

出　　处：《传染病信息》2021年第2期140-143,147,共5页Infectious Disease Information

摘　　要：目的探索血浆置换(plasma exchange,PE)结合双重血浆分子吸附系统(double plasma molecular absorb system,DPMAS)对肝硬化并发慢加急性肝衰竭患者生存状况的影响。方法2017年1月—2019年1月我院共收治3684例肝脏疾病患者,按照纳入及排除标准最终确定248例肝硬化并发慢加急性肝衰竭患者,回顾性分析其临床资料,按照治疗方式将患者分为单纯PE治疗组和PE结合DPMAS治疗组。采用电话随访以及复诊的方式统计不同治疗方式的患者4周好转率及12周生存率,收集2组患者治疗前后凝血酶原活动度(prothrombin time activity,PTA)、TBIL、ALT、AST、血红蛋白、血小板计数、血钾、血钠指标水平。采用多因素Logistic回归分析法总结影响肝硬化并发慢加急性肝衰竭患者生存状况的独立影响因素。结果PE结合DPMAS治疗组4周好转率为84.21%,12周生存率为89.47%显,均著高于单纯PE治疗组的61.94%和70.90%,数据对比和生存分析差异具有统计学意义(P<0.05)。治疗后PE结合DPMAS治疗组PTA指标升高水平显著大于单纯PE治疗组,PE结合DPMAS治疗组TBIL、ALT、AST指标降低水平明显大于单纯PE治疗组,差异均有统计学意义(P均<0.05)。PE结合DPMAS治疗组治疗后血红蛋白、血小板计数降低水平大于单纯PE治疗组,差异均有统计学意义(P均<0.05)。多因素CoX回归分析结果显示,治疗(PE或PE结合DPMAS)方法是影响肝硬化并发慢加急性肝衰竭患者生存状况的最重要影响因素(HR=2.442,P<0.05)。结论PE结合DPMAS治疗较单纯PE治疗能够显著提高肝硬化并发慢加急性肝衰竭患者近期好转率及改善患者生存状况,且能改善患者凝血功能及血细胞指标水平,适合临床推广应用。Objective To explore the effect of plasma exchange(PE)combined with double plasma molecular adsorption system(DPMAS)on the survival of patients with liver cirrhosis complicated with chronic and acute liver failure.Methods From January 2017 to January 2019,a total of 3684 patients with liver disease were admitted to our hospital.According to the inclusion and exclusion criteria,248 patients with liver cirrhosis complicated with chronic and acute liver failure were finally identified.The clinical data of the included patients were analyzed retrospectively,and according to the treatment methods,patients were divided into PE treatment group and PE combined with DPMAS treatment group.The 4-week improvement rate and the 12-week survival rate of patients treated by different treatment methods were counted by telephone follow-up and return visits.Prothrombin time activity(PTA),TBIL,ALT,AST,hemoglobin,platelet count,blood potassium and blood sodium index levels of patients were collected before and after treatment in 2 groups.The multivariate Logistic regression analysis method was used to summarize the independent influencing factors that affected the survival of patients with liver cirrhosis complicated with chronic and acute liver failure.Results The 4-week improvement rate of 84.21%and the 12-week survival rate of 89.47%in the PE combined with DPMAS treatment group were significantly higher than the 4-week improvement rate of 61.94%and the 12-week survival rate of 70.90%in the PE treatment group.Both data comparison and survival analysis showed statistically significant difference(P<0.05).After treatment,the PTA index level of the PE combined with DPMAS treatment group was significantly higher than that of the PE treatment group,while the TBIL,ALT and AST index levels of the PE combined with DPMAS treatment group were significantly lower than those of the PE treatment group.The difference was statistically significant(P<0.05).The hemoglobin and platelet counts in the PE combined with DPMAS treatment group were signifi

关 键 词：血浆置换 血浆吸附 肝硬化 慢加急性肝衰竭 

分 类 号：R575.3[医药卫生—消化系统]