人工肝支持系统治疗慢性重型肝炎的初探

A clinical study of artificial liver supporting system on patients with chronic severe heppatitis

目的 探讨目前临床应用单纯血浆置换(PE)人工肝支持治疗方法对慢性重型肝炎的临床疗效、安全性及可靠性。方法 对25例慢性重型肝炎应用PE方法进行治疗32次,通过比较治疗前后患者的临床症状、肝功能、凝血酶原活动度(PAT)、乙型肝炎病毒学指标(HBV-M)定量。三个月生存率等指标测定判断疗效,观察治疗相关的不良反应及患者的耐受性情况判断安全性及可行性。并将22例病情相近者作为对照。结果 人工肝治疗组治疗后患者乏力、腹胀、食欲等症状明显好转率达93.75％;血清胆红素(TBIL)平均下降51.81％。PAT平均上升12.45％,HBsAg、HBeAg定量分别下降52.80％和48.81％,三个月生存率88.00％(对照组40.91％)。治疗组不良反应主要为皮疹占25.00％,2例在治疗结束前半个小时出现下肢肌肉痉挛及口唇麻木,经过处理患者均能耐受直至治疗结束,仅一例发生插管处少量渗血,未发生大出血、休克、感染等不良反应。结论 PE可显著改善慢性重型肝炎患者的临床症状及生化指标,只要及早治疗,生存率可明显提高,且较安全。

Objective To evaluate the efficiency and safety of plasma exchange(PE) on patients with chronic severe hepatitis.Methods 25 patients suffering from chronic liver failure were treated with PE 32 times.The clinical symptoms,liver function,prothrombin activity quantification of hepatitis B antigen and antibody systems,3 - month survival rate before and after treatment were examined,and the treating - related side effects were recorded as well to observe the untoward reaction and the safety.Other 22 cases with similar condition were compared as control.Results The patients undergiong artificial liver treatment showed significant improvements in clinical symptoms(93 .75% ) .The serum total bilirubin fell 51.81% ,the prothrombin activity rose 12.45% ,the HBsAg fell 52.80% and HBeAg fell 48.81% .The three - month rate rose 88% ,while in the control group it only rose 40.91 % .The conventional untoward reaction were serum allergic reaction (25 % ) .Leg twitching and Lip feeling insensitive were found two times and a little bleeding from the thrusting vessel was found only one time.No severe complication such as large hemorrhage,shock and super infection were found.All patients in treatment group were well tolerated to the therapies.Conclusions PE treatment can effectively remove the pathological compositions and improved clinical symptems,serumbilirubin etc.The survival rate rose obviously and sicker as long as you use the artificial liver early.