血浆置换联合双重血浆分子吸附治疗对乙型肝炎病毒相关慢加急性肝功能衰竭肝细胞再生的影响  

Effect of Plasma Exchange Combined with Double Plasma Molecular Adsorption System on Hepatocyte Regeneration in Hepatitis B Virus-associated Acute-on-chronic Liver Failure

作　　者：杨军杰 钟炎平 毛静 刘鑫华 李姗 刘园园[2,4] 雷旭 雷飞飞 雷雨 郭鹏 胡波[1,2] 刘志新 谭华炳 YANG Junjie;ZHONG Yanping;MAO Jing;LIU Xinhua;LI Shan;LIU Yuanyuan;LEI Xu;LEI Feifei;LEI Yu;GUO Peng;HU Bo;LIU Zhixin;TAN Huabing(Postgraduate Training Basement of Jinzhou Medical University,Shiyan Renmin Hospital,Shiyan 442000,China;不详)

机构地区：[1]锦州医科大学十堰市人民医院研究生培养基地,湖北十堰442000 [2]湖北省十堰市人民医院(湖北医药学院附属人民医院) [3]湖北医药学院附属国药东风总医院 [4]湖北省随州市中心医院(湖北医药学院附属随州医院) [5]湖北省房县人民医院

出　　处：《中国医学创新》2023年第5期63-69,共7页Medical Innovation of China

基　　金：国家自然科学基金青年科学基金资助项目(81902066);2014年度湖北省教育厅科学研究计划项目(Q20142106);2021年十堰市科学技术研究与开发项目计划(2021K65);2021年十堰市科技局引导性科研项目(21Y63);2022年度十堰市科技局引导性科研项目(22Y69);2022年湖北医药学院研究生科技创新项目(2022HBUMY066);2022年肝胆相照公益基金会“人工肝专项基金”(iGandanF1082022RGG030)。

摘　　要：目的:观察血浆置换(PE)+双重血浆分子吸附系统治疗(DPMAS)对乙型肝炎病毒相关慢加急性肝功能衰竭(HBV-ACLF)患者肝细胞再生的影响。方法:回顾性分析2019年1月-2021年12月十堰市人民医院住院治疗的156例HBV-ACLF患者,根据治疗方式分为PE组(44例)、PE+DPMAS组(69例)、对照组(43例)。对照组行抗病毒、促肝细胞再生等内科综合治疗,PE组及PE+DPMAS组在对照组治疗基础上分别行PE、PE+DPMAS。统计各组治疗前后乙肝DNA(HBV-DNA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、白蛋白(ALB)、血白细胞(WBC)、血小板(PLT)、血肌酐(Scr)、凝血酶原时间国际化标准比值(INR)、甲胎蛋白(AFP)。根据TBIL、ALB、Scr、INR、AFP数据,应用慢加急性肝衰竭预后模型TACIA评分公式,计算各组治疗前后TACIA评分。结果:PE组、PE+DPMAS组治疗后TBIL、DBIL、IBIL均较治疗前下降,差异均有统计学意义(P<0.05);对照组治疗前后的TBIL、DBIL、IBIL对比,差异均无统计学意义(P>0.05)。PE组、PE+DPMAS组治疗后INR指标均较治疗前下降,差异均有统计学意义(P<0.05);对照组治疗后INR指标较治疗前下降,差异有统计学意义(P<0.05)。PE+DPMAS组AFP治疗后较治疗前升高,差异有统计学意义(P=0.009),PE组、对照组AFP治疗前后对比,差异均无统计学意义(P>0.05)。PE组治疗后TACIA评分较治疗前下降,差异有统计学意义(P=0.010),PE+DPMAS组治疗后TACIA评分较治疗前下降,差异有统计学意义(P=0.000),在对照组治疗前后相比,差异无统计学意义(P=0.107)。PE组治疗有效率高于对照组,差异有统计学意义(P=0.005),PE+DPMAS组治疗有效率高于对照组,差异有统计学意义(P=0.000),但PE+DPMAS组与PE组比较,差异无统计学意义(P=0.683)。结论:PE+DPMAS能有效清除胆红素等有害物质,改善肝细胞再生环境、促进肝再生,改善HBV-ACLF患者预后。Objective:To observe the effect of plasma exchange(PE)+double plasma molecular adsorption system(DPMAS)on hepatocyte regeneration in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).Method:A total of 156 patients with HBV-ACLF hospitalized in Shiyan People’s Hospital from January 2019 to December 2021 were analyzed retrospectively,and divided into PE group(44 cases),PE+DPMAS group(69 cases)and control group(43 cases)according to treatment methods.The control group was treated with anti-virus,hepatocyte regeneration and other comprehensive medical treatments.The PE group and the PE+DPMAS group were treated with PE,PE+DPMAS on the basis of the control group.Before and after treatment,the hepatitis B virus DNA(HBV-DNA),alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),albumin(ALB),white blood cell(WBC),platelet(PLT),creatinine(Scr),prothrombin time activity(PTA),international normalized ratio(INR)of prothrombin time,alpha-fetal protein(AFP)in each group were analyzed.According to TBIL,ALB,Scr,INR,AFP data,TACIA scoring formula was applied,TACIA scores before and after treatment were calculated.Result:The TBIL,DBIL and IBIL decreased significantly after treatment in the PE group and PE+DPMAS group compared with those before treatment(P<0.05).There were no significant differences between TBIL,DBIL and IBIL before and after treatment in the control group(P>0.05).The INR index of PE group and PE+DPMAS group decreased significantly compared with those before treatment(P<0.05).The INR index of the control group decreased significantly after treatment compared with that before treatment(P<0.05).AFP was significantly higher in the PE+DPMAS group than that before treatment(P=0.009).There were no significant differences between AFP before and after treatment in PE group and control group(P>0.05).The TACIA scores decreased statistically significantly after treatment in PE group compared with that before treatment(P=0.

关 键 词：乙型肝炎病毒 慢加急性肝功能衰竭 血浆置换 双重血浆分子吸附 甲胎蛋白 TACIA评分 

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