血浆置换治疗对慢性乙型重型肝炎患者血清甲胎蛋白水平的影响

The influence of plasma exchange on the serum level of AFP in patients with chronic severe hepatitis B

目的了解血浆置换治疗对重型肝炎患者血清甲胎蛋白的影响。方法应用日本可乐丽公司第四代KPS8800Ce人工肝治疗仪,对31慢性重型乙型肝炎患者进行血浆置换治疗,每次置换3 000ml新鲜冰冻血浆,对所有患者分别在术前、术后、术后10天采外周静脉血检测肝功能、血氨、凝血酶原时间等指标及外周血甲胎蛋白(AFP)含量。结果31例重症肝炎患者在血浆置换术后外周血总胆红素、血氨、谷丙转氨酶及谷草转氨酶、凝血酶原时间等各项指标均明显下降(P<0.01);血清AFP含量在血浆置换治疗术前有一定程度的升高(76.82±89.44ng/ml);而术后、术后10天血清分别为38.54±72.12、45.4±55.6 ng/ml,均较术前的AFP水平明显降低(P<0.05)。结论血浆置换能有效地清除患者体内的毒素,是重型肝炎治疗的有效方法之一;该治疗方法对血清甲胎蛋白水平影响不大。

Objective To investigate the effects of plasma exchange on serum alpha fetoprotein in patients with severe viral hepatitis. Methods 31 hospitalized patients enrolled during 2003-2005 received plasma exchange therapy. The plasma exchange was performed by using a membrane separation method marketed as Plasmacure PS-06 （Kuraray Co. ,Japan）. The total volume of exchanged fresh frozen plasma was about 3000 mL. The liver function and the serum ammonia, prothrombin time （PT） and alphafetoprotein （AFP） were examined in all patients before, immediately after and 10 days after plasma exchange. Result The liver function tests of all patients were significantly improved after plasma exchange. The levels of serum total bilirubin, transaminases, PT and ammonia were decreased significantly （P〈0. 05）. The levels of serum alphafetoprotein after plasma exchange was significantly lower than before [ 38.54±72. 12 vs. 76. 82 ±89. 44 ng/ml,respectively（P〈0.01）]. The levels of AFP on 10 days after plasma exchange was 45.4±55.6 ng/ml. Conclusion Plasma exchange can remove the toxin from body and supply the essential material and is an effective and safe therapy for severe hepatitis.