非生物型人工肝对肝衰竭患者疗效和预后的影响

Non-biological artificial liver to improve the curative effect of hepatic failure patients but not improve prognosis

目的探讨非生物型人工肝对乙型病毒性肝炎肝衰竭患者疗效和预后的影响。方法对我科收治的308例乙型病毒性肝炎肝衰竭患者进行前瞻性队列研究，按照不同治疗方法分为人工肝（ALSS）组217例和标准药物治疗（SMT）组91例。两组患者以治疗8周为疗效观察节点，以48周为预后观察终点。记录患者的症状及肝功能、凝血功能等生化指标变化及其生存时间。应用SPSS17．0软件绘制生存曲线，组间生存率的比较采用Log—rank检验。结果ALSS组患者血清ALT、总胆红素（TBil）水平较人工肝治疗前分别平均下降63．6U／L和34．17μmol／L，凝血酶原活动度（PTA）平均升高7．71％（P〈0．01）。在治疗8周时，ALSS组的临床有效率高于SMT组（52．07％比34．07％，P〈0．01）；至12周时，ALss组和SMT组的累积生存率分别为50．4％和42．1％，两者比较差异无统计学意义（p〉0．05）；至48周结束时，ALSS组患者的平均生存时间为（186．2±11．5）天，SMT组患者的平均生存时间为（160．3±19．0）天，两组患者1年累积生存率比较差异无统计学意义（44．3％比40．7％，P〉0．05）。结论非生物型人工肝可以改善乙型病毒性肝炎肝衰竭患者的临床疗效，但并不能提高其生存率。

Objective To investigate non-bioartificial liver＇s influence on clinical efficacy and prognosis of patients with chronic hepatitis B related liver failure. Methods 308 cases of patients who hospitalized in Tongji Hospital（Wuhan） were analyzed in perspective clinical study. Patients who accepted both non-bioartificial hver and standard medical treatment were defined as ALSS group. The ones who accepted standard medical therapy only were defined as SMT group. Taking S-week as an observation point,we recorded patients＇ symptoms and biochemical parameters, such as liver function and clotting function. According to them, we could determine the clinical efficacy of patients. Taking the time when patients admitted to hospital and accepted treatment as a starting point, and we took 48 weeks as ending point and recorded the survival time of cases. We took advantage of SPSS 17.0 statistical software to make survival curve and by which to determine the prognosis of our patients with liver failure. The difference of survival rate between two groups was compared by Log Rank test. Results Non-bioartificial liver could improve clinical symptoms and signs, liver function and coagulation function of patients with liver failure （ comparing with pre-artificial liver,the level of ALT,TBil were reduced by 63.6 U/L and 34.17 p.mol/L respectively,PTA was increased by 7.71% average, P 〈 0.01 ）. At 8-week, the difference of clinical efficiency between ALSS group and SMT group was of statistical significance（52.07% vs 34.07% ,P 〈 0.01 ）. 12-week cumulative survival rate of ALSS group and SMT group were 50.4% and 42.1% respec- tively, the difference between them was not statistical significant（ P 〉 0.05 ）. After following up one year, the average survival time of patients in ALSS group was（ 186.2 ± 11.5 ） days while it was（ 160.3 ± 19.0） days in SMT group patients. The difference of one year cumulative survival rate between two groups was not statistical significant （44. 3% vs 40. 7%, P 〉 0. 05 ）. Conclusion Non-bioartificial liver could improve clinical effficiency,while it could not improve prognosis.