人工肝支持系统血浆置换治疗重型肝炎的临床研究

Clinical study on treatment of severe hepatitis by plasma exchange

目的 :探讨人工肝支持系统 (ALSS)血浆置换 (PE)治疗重型病毒性肝炎的疗效。方法 :重型肝炎 139例 ,设治疗组及对照组 ,两组均采用重型肝炎的常规治疗 ,治疗组同时加用PE治疗 ,并检测治疗前后肝功能、血氨、血清HBV -DNA定量、肾功、电解质、观察临床症状体征及预后。结果 :PE治疗后肝功能明显改善 ,血氨下降由 12 7.91± 5 7.33(μmol/l)降至 81.5 1±4 0 .2 0 (μmol/l) (P <0 .0 0 1) ,血清HBV -DNA定量水平平均对数值 (Log10copy/ml)由 5 .72± 1.39降至 4 .5 3± 1.35 (P <0 .0 5 )。治疗组治愈好转率明显高于对照组 ,分别为 6 7.0 3% (6 1/ 91)、5 0 .0 % (2 4 / 4 8)P <0 .0 5 ,其中又以重型肝炎早期、中期组治愈好转率较对照组明显提高 ,分别为 95 % (19/ 2 0 )、72 .2 7% (8/ 11)及 82 .0 5 % (32 / 39)、5 7.14 (12 / 2 1)。结论 :PE治疗可提高重型肝炎疗效 ,以早、中期最为适宜 。

Objective:To evaluate the efficacy and mechanism of plasma exchange (PE) in the treatment of severe hepatitis.Methods:139 patients with severe hepatitis were divided into treated and control groups.Both groups were treated with the same routine therapies,but the treated group received the PE.The liver function and serum ammonia,concentration of serum HBV-DNA spectrum were detected before and after treatment with PE.The efficacy and safety were evaluated with clinical parameters respectively.Results:Liver function was significantly improved after PE therapy.There was significant decrease in concentration of serum ammonia from 127.91±57.33 (ixnol/L) to 81.51±40.20 (μmol/L) P <0.001,concentration of serum HBV-DNA(Log10copy/ml) from 5.72±1.39 to 4.13±1.35( P <0.005).Compared with the control group,there was significantly increased cure and improved rate in the treated group [67.03(61/91) vs 50.0 %(24/48)]( P <0.05).The response rates of severe hepatitis in early stage,middle stage were 95 %(19/20) vs 72.27%(8/11) ( P <0.05) and 82.50 %(32/39) vs 57.14 %(12/21) respectively ( P <0.05).Conclusion:PE treatment of severe hepatitis is effective,especially in early and middle stages.