HBV相关性慢加急性肝衰竭等待肝移植患者血浆置换疗效影响因素  

Influencing factors of curative effect of plasma exchange in patients with HBV-related acute-on-chronic liver failure waiting for liver transplantation

作　　者：孙克彦 毛家玺 刘业 刘聪 郭闻渊 张磊[1] 滕飞 Sun Keyan;Mao Jiaxi;Liu Ye;Liu Cong;Guo Wenyuan;Zhang Lei;Teng Fei(Department of General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Hepatobiliary Surgery,Shanghai Changzheng Hospital Affiliated to Naval Medical University,Shanghai 200003,China;Department of Blood Transfusion,Shanghai Changzheng Hospital Affiliated to Naval Medical University,Shanghai 200003,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科,200025 [2]海军军医大学长征医院肝脏外科,200003 [3]海军军医大学长征医院输血科,200003

出　　处：《中华肝脏外科手术学电子杂志》2022年第3期252-257,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81971503);国家自然科学基金青年项目(81702923);长征医院军事医学科研专项(2019CZJS222)。

摘　　要：目的探讨HBV相关性慢加急性肝衰竭(HBV-ACLF)等待肝移植患者血浆置换疗效的影响因素。方法回顾性分析2016年12月至2019年12月在上海交通大学医学院附属瑞金医院和海军军医大学长征医院接受血浆置换的63例HBV-ACLF等待肝移植患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男54例,女9例;平均年龄(51±9)岁。根据最终结局将患者分为预后良好组(30例)和预后较差组(33例),观察血浆置换前后Scr、WBC、TB、血氨(BA)等指标变化,分析影响疗效的因素。两组Scr_(max)、WBC_(max)等指标比较采用Kolmogorov-Smirnov检验,ROC曲线评估指标的预测价值。结果预后良好组和预后较差组血浆置换前Scr_(max)分别为74(68)、111(74)μmol/L,WBC_(max)分别为8(5)×10^(9)/L、14(13)×10^(9)/L,两组比较差异有统计学意义(Z=1.670,2.402;P<0.05)。预后良好组和预后较差组血浆置换前后TB_(max)差值分别为-37%(28%)、-23%(38%),BA_(max)分别为-29%(46%)、20%(105%),两组比较差异有统计学意义(Z=1.718,2.030;P<0.05)。ROC曲线分析显示,血浆置换前Scr_(max)≥78.5μmol/L、WBC_(max)≥12.3×10^(9)/L提示预后较差,TB降低24.5%,BA升高控制不超过原基础14%可使患者获得较好的预后。结论影响HBV-ACLF等待肝移植患者血浆置换疗效的关键因素在于术前肾功能、炎性指标及血浆置换后TB和BA改善程度,而非血浆置换的次数和用量。Objective To explore the influencing factors of curative effect of plasma exchange in patients with HBV-related acute-on-chronic liver failure(HBV-ACLF)waiting for liver transplantation(LT).Methods Clinical data of 63 HBV-ACLF patients waiting for LT who received plasma exchange in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Changzheng Hospital Affiliated to Naval Medical University from December 2016 to December 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,54 patients were male and 9 female,aged(51±9)years on average.According to clinical prognosis,all patients were divided into the good(n=30)and poor prognosis groups(n=33).The changes of Scr,WBC,TB,blood ammonia(BA)and other indexes before and after plasma exchange were observed,and the influencing factors of curative effect of plasma exchange were analyzed.Scr_(max),WBC_(max) and other indexes between two groups were compared by Kolmogorov-Smirnov test.The predictive value of these indexes was assessed by ROC curve.Results Before plasma exchange,the Scr_(max) were 74(68)μmol/L and 111(74)μmol/L in the good and poor prognosis groups,and the WBC_(max) were 8(5)×10^(9)/L and 14(13)×10^(9)/L,where significant differences were observed(Z=1.670,2.402;P<0.05).In the good and poor prognosis groups,the differences of TB_(max) and BA_(max) before and after plasma exchange were-37%(28%)and-23%(38%),-29%(46%)and 20%(105%),where significant differences were observed(Z=1.718,2.030;P<0.05).ROC curve analysis showed that Scrmax≥78.5μmol/L and WBC_(max)≥12.3×10^(9)/L before plasma exchange indicated poor prognosis,whereas TB decrease by 24.5%and BA increase by≤14%of baseline level indicated good prognosis.Conclusions The key influencing factors of curative effect of plasma exchange in HBV-ACLF patients waiting for LT include preoperative renal function,inflammatory indexes and the improvement of TB and BA after

关 键 词：肝炎病毒 乙型 肝功能衰竭 肝移植 血浆置换 人工肝 

分 类 号：R65[医药卫生—外科学]