人工肝支持系统治疗慢性乙型重型肝炎的临床观察

Clinical observation of artifical liver supporting systems on the treatment of patients with chronic severe hepatitis B

目的探讨人工肝支持系统对慢性乙型重型肝炎的临床疗效及安全性。方法对37例慢性乙型重型肝炎患者根据病情分别选择血浆置换、血浆置换联合持续血液滤过透析和分子吸附再循环系统3种人工肝支持方法进行86例次治疗,比较治疗前后患者临床症状、肝功能、肾功能、血氨、凝血功能等指标,判断临床疗效,观察不良反应,以同期住院的33例常规综合治疗患者为对照组。结果治疗后患者症状明显缓解,血清总胆红素治疗前424.33±120.67μmol/L,治疗后降至331.09±117.91μmol/L,总胆汁酸、血氨下降、凝血酶原时间缩短、凝血酶原活动度上升(P<0.01),不良反应主要为发热和皮疹,3例次治疗中出现明显血压下降,经对症处理能较快恢复,1例次MARS治疗结束时出现消化道出血。治疗组生存率为35.1%,高于对照组的21.2%(P<0.01)。结论人工肝支持系统能显著改善慢性乙型重型肝炎患者临床症状及生化指标,提高近期存活率。

Objective To explore clinical effects of artifical liver supporting systems (ALSS) on the treatment of patients with chronic severe hepatitis B.Methods Plasma exchange (PE),continuous hemodialysis and filtration(CHDF) and molecular adsorbent recirculating system(MARS) were applied in 37 patients with chronic severe hepatitis B according to patient's condition to judge clinical effect through observing some markers of patients before and after treatment such as clinical symptoms,liver function,renal function,blood ammonia and coagulopathy.33 patients treated with routine methods at the same period were taken as control.Results Anorexia and abdominal distention were alleviated after treatment.The total serum bilirubin levels decreased from 424.33±120.67 to 331.09±117.91μmol/L.Blood total bile acid,blood ammonia,prothrombin time decreased and prothrombin activity (PTA) increased significantly.The main side effect was fever and skin eruption.Blood pressure decreased notably in 3 cases,but it was restored quickly after treatment.Gastrointestinal bleeding occurred in one case at the end of MARS treatment.Conclusion ALSS can improve clinical symptoms and biochemical markers in severe hepatitis patients with the increased survival rate.