组合型非生物人工肝支持治疗重型肝炎的临床研究

Clinical research of joint system of artificial liver support on treating patients with severe viral hepatitis B

评价组合人工肝支持系统——血浆置换(Plasma change,PE)联合在线连续静脉-静脉血液滤过(on-line CVVHF)治疗重型肝炎的临床疗效、机制及可行性。将64例中晚期慢性乙型重型肝炎患者随机分为3组:A组23例内科常规治疗加PE联合on-line CVVHF;B组21例内科常规治疗加PE;C组仅予内科常规治疗。比较3组治疗后肝性脑病意识转清率,各项生化指标的变化并观察3组近期疗效及生存率。治疗后A组肝性脑病意识转清率60%,血胆红素、血氨、尿素氮、内毒素、肿瘤坏死因子水平明显降低,近期有效率81.5%,生存率45.5%;与B组比较有统计学意义(P<0.05)。内科治疗加PE联合on-lineCVVHF能够提高脑病苏醒率,显著改善生化指标,提高近期生存率,且方便可行,应作为非生物人工肝支持的主要方法。

To evaluate the clinical efficacy and study the mechanism of combining plasma exchange （ PE ） and on - line continuous veno - venous hemofihration （CVVHF） in treating patients with chronic severe viral hepatitis B. 64 patients suffering from chronic severe viral hepatitis B were divided into 3 groups randomly. 23 patients were treated with plasma exchange plus continuous veno - venous hemofihration （ group A ）. 21 patients were treated with plasma exchange alone （goup B）. 20 patients received routine treatment （group C ）. The efficacy of treatment and survival rates of the three groups were analyzed after artificial liver support system treatment. And the laboratory examination and the degree of hepatic encephalopathy were investigated. In group A, 6 of the 10 patients in coma regained normal consciousness （ 60. 0% ） and their survival rate was 45.5%. There was statistically significant difference between group A and B. Routine treatment uniting PE and on - line CVVHF on treating patients with chronic severe viral hepatitis B could increase survival rate. This therapy was a safe and promising technology and should be used as chief method of artificial liver support system.