血浆置换治疗慢性重型肝炎60例临床分析

Retrospective analysis of plasma exchange for chronic severe hepatitis

目的回顾分析慢性重型肝炎患者行血浆置换术(plasma exchange,PE)的疗效及其影响因素。方法应用血浆置换联合内科综合治疗60例慢性重型肝炎患者,分析总结患者的治疗效果和影响疗效的有关因素。结果60例慢性重型肝炎患者经血浆置换治疗后有效率为61.7%。PE的疗效与患者年龄、临床分期、PE治疗前血清胆红素值及凝血酶原活动度(PTA)、并发症的发生率有密切关系(P<0.01)。PE的疗效与治疗次数无明显关系(P>0.05)。结论行血浆置换术可明显提高慢性重型肝炎患者的存活率,尤其是对于年龄在60岁以下、血清总胆红素(TBIL)水平较低、PTA值较高、临床处于早中期的患者。改善重型肝炎的预后仍需针对患者病情特点早期治疗,积极防治并发症。

Objective To retrospectively analyse the efficacy and the influencing factors of plasma exchange （PE） in patients with chronic severe hepatitis. Methods Sixty patients of chronic severe hepatitis were included. Results The effective rate was 61.7%. The efficacy of PE was closely related to age, clinical stage, prereatment serum bilirubin values, prothrombin activity and incidence of complications （ P 〈 0.01 ）. No significant correlation was observed between the efficacy and the treatment frequency of PE （ P 〉 0.05 ）. Conclusion PE can significantly improve the survival of patients with chronic severe hepatitis. Especially for the patients under 60 years old, those with low serum TBIL level and high PTA, and those in the early clinical stage, PE treatment would achieve a better efficacy. But the improvement of prognosis of severe hepatitis still depends on the early specific treatment and active prevention of complications.