血浆置换治疗重型肝炎的影响因素分析

Analysis on the factors influencing the prognosis of severe hepatitis patients treated by plasma exchange

目的探讨血浆置换治疗重型肝炎的疗效及其影响因素。方法对62例血浆置换治疗重型肝炎临床资料进行系统性回顾分析。结果早、中、晚期有效率(治愈或好转)分别为88.2%、64.3%、23.5%。随着年龄的增加、治疗前血清胆红素及治疗后胆红素反弹率升高、治疗前凝血酶原活动度(PTA)及血清白蛋白下降疗效逐渐下降。并发肝肾综合症、肝性脑病、上消化道出血预后差。治疗前无效组血清中LPS、TNF-α、IL-18、NO水平高于有效组;有效组治疗后病情好转时细胞因子水平下降,而无效组病情加重时无变化。结论年龄、临床分期、血清白蛋白、PTA、总胆红素、胆红素反弹率、细胞因子水平、并发症是影响血浆置换治疗重型肝炎疗效的相关因素。

Objective To study the effect and influencing factors of plasma exchange in the treatment of severe hepatitis. Methods Clinical data of 62 patients with severe hepatitis treated by plasma exchange were analyzed retrospectively. Results After plasma exchange, the effective rates （cure or improvement） of serve hepatitis at early stage, middle stage and late stage were 88.2%, 64.3% and 23.5% respectively. The response rate was gradually lower along with the increase of age and the serum bilirubin before treatment and rise again of the serum bilirubin after plasma exchange, and along with the decrease of prothrobinogen activity and the serum albumin before treatment. Among all the complications, hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal bleeding had the worst prognosis. The levels of serum LPS, TNF-α, IL-18 and NO in effective group were lower than those in ineffective group before treatment. The levels of cytokines dropped in effective group when patients＇ condition ameliorated （P〈0. 01）, but there was no difference in the levels of cytokines when patients＇ condition aggravated as compared with those at admission in ineffective group （P〉0.05）. Conclusion The stage of severe hepatitis, the levels of serum albumin, bilirubin, cytokines, PTA, and complications are relevant factors influencing the prognosis of patients with severe hepatitis treated by plasma exchange.