人工肝多模式联合序贯治疗乙型肝炎病毒相关慢加急性肝衰竭患者的疗效  

Efficacy of multimodal artificial liver combined with sequential treatment in patients with acute liver failure induced by exacerbation of chronic liver disease related to hepatitis B virus

作　　者：胡震霆[1] 邱荣仙[1] 黄晓刚[1] 郑烽锋[1] Hu Zhenting;Qiu Rongxian;Huang Xiaogang;Zheng Fengfeng(Department of Infectious Disease,the Affiliated Hospital of Putian College,Putian,Fujian 351100,China.)

机构地区：[1]莆田学院附属医院感染性疾病科,福建莆田351100

出　　处：《齐齐哈尔医学院学报》2024年第6期518-522,共5页Journal of Qiqihar Medical University

基　　金：福建省自然科学基金计划项目(2021J011293)。

摘　　要：目的 观察慢加急性肝衰竭(乙型肝炎病毒相关)患者采用人工肝多模式联合序贯治疗的疗效。方法 选择2022年5月—2023年5月本院诊治的112例慢加急性肝衰竭患者作为研究对象,根据治疗方法不同分为序贯联合组(47例)和常规组(65例)两组。常规组患者进行常规模式治疗,行血浆置换联合连续性肾脏替代治疗,根据患者肝功能与凝血功能情况,选择血浆置换联合双重血浆分子吸附或血浆透析滤过。序贯联合组患者第1天予以血浆置换、连续性肾脏替代治疗,第2天予以血浆置换、双重血浆分子吸附,第3天予以血浆透析滤过;3 d后观察患者肝功能与凝血情况,以上述模式再进行3次人工肝治疗。比较两组患者实验室检查结果、临床疗效、细胞因子水平、并发症发生情况。结果 序贯联合组患者白细胞计数与肌酐水平为(6.2±2.0)×10^(9)/L、(61.1±14.7)μmol/L,均低于常规组[(7.9±2.4)×10^(9)/L、(74.6±21.3)μmol/L](P<0.05)。序贯联合组患者治疗好转率、治疗有效率及12周存活率分别为61.7%、66.0%、59.6%,均高于常规组的30.8%、13.8%、27.7%(P<0.05)。序贯联合组患者治疗后γ干扰素诱导蛋白10、白细胞介素-6、白细胞介素-8水平分别为(91.3±8.1)ng/L、(30.6±7.4)ng/L、(78.4±7.2)ng/L,均低于常规组[(96.2±11.3)ng/L、(35.1±7.7)ng/L、(82.4±7.7)ng/L](P<0.05)。序贯联合组患者并发症总发生率为10.6%,低于常规组的26.2%(P<0.05)。结论 慢加急性肝衰竭(乙型肝炎病毒相关)患者采取人工肝多模式联合序贯治疗疗效确切,可有效清除细胞因子,促使肝功能得到明显改善,延长患者生存期。Objective To observe the efficacy of multimodal artificial liver combined with sequential treatment in patients with acute liver failure induced by exacerbation of chronic liver disease(hepatitis B virus related).Methods During May 2022 and May 2023,112 patients with acute liver failure induced by exacerbation of chronic liver disease who were treated in our hospital were enrolled as study subjects,and they were divided into the sequential combination group(47 cases)and the conventional group(65 cases)according to different treatment methods.Patients in the conventional group were treated with conventional therapy mode,plasma exchange combined with continuous renal replacement therapy was adopted.Based on the patient's liver function and coagulation function,plasma exchange combined with dual plasma molecule adsorption or plasma dialysis filtration was chosen.Patients in the sequential combination group received plasma exchange and continuous renal replacement therapy on the first day,plasma exchange and dual plasma molecule adsorption on the second day,and plasma dialysis filtration on the third day;After 3 days,the patient's liver function and coagulation status were observed,and three more artificial liver treatments were performed using the above mode.The laboratory examination results,clinical efficacy,cytokine levels,and incidence of complications was compared between the two groups of patients.Results The leukocyte cell count and creatinine level of patients in the sequential combination group were(6.2±2.0)×10^(9)/L,(61.1±14.7)μmol/L,which were significantly lower than those of the conventional group[(7.9±2.4)×10^(9)/L,(74.6±21.3)μmol/L,all P<0.05].The treatment improvement rate,treatment effectiveness rate,and 12 week survival rate of patients in the sequential combination group were 61.7%,66.0%,and 59.6%,respectively,significantly higher than 30.8%,13.8%,and 27.7%in the conventional group(all P<0.05).After treatment,the levels ofγinterferon induced protein 10,interleukin-6,and interleukin-8 in t

关 键 词：肝衰竭 慢加急性 人工肝 多模式序贯 

分 类 号：R575.3[医药卫生—消化系统]