分子吸附再循环系统及血浆置换在重型肝炎治疗中的疗效比较

Comparison of molecular adsorbent recirculating system with plasma exchange in the treatment of patients with severe hepatitis

目的 比较分子吸附再循环系统 (molecularadsorbentrecirculatingsystem ,MARS)及血浆置换 (plasmaexchange ,PE)治疗重型肝炎患者的临床疗效。方法 3 80例急性、亚急性及慢性重型肝炎患者中 ,MARS组 60例、PE组 3 0 0例及MARS +PE组 2 0例。比较三组的治愈好转率、肝性脑病的改善、血清胆红素 (SBIL)及凝血酶原活动度 (PTA)的变化。结果 3 80例患者总的治愈好转率为 48 9% ( 186/3 80 ) ,其中MARS组 5 8% ( 3 5 /60 ) ,PE组 46% ( 13 8/3 0 0 ) ,MARS +PE组 64 %( 13 /2 0 ) ;67例并发肝性脑病者中 ,18例应用MARS治疗后 5例神志转清、7例神志改善、6例无效 ,有效率 67% ;49例应用PE治疗后 11例神志转清、16例神志改善、2 2例无效 ,有效率 5 5 % ,两组差异有显著性 (P <0 0 5 ) ;与治疗前比较 ,治疗结束及 2天后SBIL较治疗前下降 :MARS组为 2 9%及 2 1%、PE组为 3 7%及 19% ;治疗结束时PTA∶MARS组无明显变化 ,PE组则平均提高 2 0 % ,但 2天后复查又接近治疗前水平。结论 MARS及PE对重型肝炎患者均有较好的临床疗效 ,MARS治疗后病情的稳定性要优于PE 。

ObjectiveTo compare the efficacy of molecular adsorbent recirculating system(MARS) with plasma exchange(PE)in the treatment of patients with severe hepatitis.Methods380 patients were treated with MARS(60)and PE(300)or MARS plus PE(20).The patients's serum samples were detected at the different time of treatment.ResultsThe overall survival rate was 48.9%(186/380):58%(35/60)in MARS group,46%(138/300)in PE group and 64%(13/20)in MARS plus PE group.41 of 67 HE patients' consciousness were normal or improved gradually after treatments:12 of 18(67%)in MARS group,27 of 49(55%)in PE group (P<0.05).29% and 21% serum bilirubin was reduced significantly at the end or two days later after the MARS treatment,37% and 19% after PE.The prothrombin time activity did not change significantly in MARS group,while 20% elevated in PE group.ConclusionMARS and PE are safe and effective for the patients with severe hepatitis.MARS treatment is better than PE in the efficacy stability.