人工肝治疗肝衰竭患者血红蛋白水平的变化及其影响因素  

Changes in hemoglobin and related influencing factors in patients with liver failure undergoing artificial liver support therapy

作　　者：林英 陈力 彭菲 林建辉 卓传尚 LIN Ying;CHEN Li;PENG Fei;LIN Jianhui;ZHUO Chuanshang(Department of Blood Transfusion,Mengchao Hepatobiliary Hospital ofFujian Medical University,Fuzhou 350001,China;Artificial Liver Center,Mengchao Hepatobiliary Hospital ofFujian Medical University,Fuzhou 350001,China;Department of Liver Diseases,Mengchao Hepatobiliary Hospital ofFujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学孟超肝胆医院输血科,福州350001 [2]福建医科大学孟超肝胆医院人工肝中心,福州350001 [3]福建医科大学孟超肝胆医院肝病科,福州350001

出　　处：《临床肝胆病杂志》2025年第1期104-109,共6页Journal of Clinical Hepatology

基　　金：福州市“十四五”临床重点专科(20220203);福建省自然科学基金(2020J011158,2021J011293)。

摘　　要：目的探讨肝衰竭患者接受人工肝治疗后血红蛋白(Hb)变化趋势和影响因素。方法选取2018年1月—12月在福建医科大学孟超肝胆医院接受人工肝治疗的肝衰竭患者106例,分析患者的临床资料与Hb、平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)和红细胞分布宽度变异系数(RDW-CV)等红细胞参数。重复测量资料组间比较采用单因素重复测量方差分析,两两比较采用配对t检验;偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验,两两比较采用Mann-Whitney U检验。采用单因素及多因素线性回归分析人工肝治疗后Hb降低的影响因素。结果106例肝衰竭患者接受606人次人工肝治疗,其中402人次治疗前后均有Hb检测结果,肝衰竭患者接受人工肝治疗术后Hb[(97.49±20.51)g/L]较术前[(109.38±20.22)g/L]下降(t=32.764,P<0.001)。进一步对14例肝衰竭患者纵向观察,末次人工肝治疗术前Hb为(108.50±21.61)g/L,术后次日Hb[(103.14±19.15)g/L]较前恢复,术后第3天Hb[(102.57±21.73)g/L]未进一步回升,术后第7天Hb再次升高[(105.57±22.04)g/L]。肝衰竭患者术后次日Hb水平随着治疗次数的增加而降低(F=8.996,P<0.001),而MCV和MCH随着治疗次数的增加逐渐增高(F值分别为9.154和13.460,P值分别为0.004和<0.001),RDW-CV则先逐渐升高后下降(F=4.520,P=0.032),MCHC呈上下波动,无明显趋势(F=0.811,P=0.494)。多因素线性回归分析显示,人工肝操作时长、模式和首次治疗是人工肝治疗后Hb减少的独立危险因素(P值均<0.05)。结论人工肝治疗可影响肝衰竭患者外周Hb水平,应加强肝衰竭人工肝治疗期间的患者血液管理。Objective To investigate the changing trend of hemoglobin(Hb)and related influencing factors in patients with liver failure after artificial liver support system(ALSS)therapy.Methods A total of 106 patients with liver failure who were hospitalized and received ALSS therapy in our hospital from January to December 2018 were enrolled and analyzed in terms of clinical data and red blood cell parameters such as Hb,mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),mean corpuscular hemoglobin concentration(MCHC),and red blood cell distribution width-coefficient of variation(RDW-CV).A one-way repeated-measures analysis of variance was used for comparison of continuous data with repeated measurement between groups,and the paired t-test was used for comparison between two groups.The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups,the Mann-Whitney U test was used for further comparison between two groups.Univariate and multivariate linear regression analyses were used to identify the influencing factors for the eduction in Hb after ALSS therapy.Results The 106 patients with liver failure received 606 sessions of ALSS therapy,and Hb was measured for 402 sessions before and after treatment.There was a significant reduction in Hb after ALSS therapy in the patients with liver failure(97.49±20.51 g/L vs 109.38±20.22 g/L,t=32.764,P<0.001).Longitudinal observation was further performed for 14 patients with liver failure,and the results showed that the level of Hb was 108.50±21.61 g/L before the last session of ALSS therapy,with certain recovery compared with the level of Hb(103.14±19.15 g/L)on the second day after ALSS,and there was an increase in Hb on day 3(102.57±21.73 g/L)and day 7(105.57±22.04 g/L)after surgery.The level of Hb in patients with liver failure on the second day after ALSS decreased with the increase in the number of ALSS sessions(F=8.996,P<0.001),while MCV and MCH gradually increased with the increase in the number of ALSS sessi

关 键 词：肝功能衰竭 肝 人工 血红蛋白类 

分 类 号：R575.3[医药卫生—消化系统]