血浆置换(PE)治疗重型肝炎的临床评价

The evaluation of the PE to treat the chronic severe hepatitis.

目的探讨人工肝-血浆置换(PE)治疗慢性重型肝炎的临床疗效、时机及安全性。方法选择我科经过血浆置换(PE)的慢性重型肝炎患者83例设为治疗组,比较其治疗前后主要实验室指标的变化;未经过血浆置换(PE)的慢性重型肝炎患者80例设为对照组,比较两组不同治疗时期的有效率、总有效率和近期存活率。结果治疗组每次治疗后症状、精神、食欲、体力均有改善,血清ALT、AST、TBil、BDil、PT、PTA均明显好转,外周血细胞和血清电解质无显著变化;治疗组早、中期有效率分别为87.10%、69.70%,总有效率63.86%,明显高于对照组的51.85%、38.71%和37.50%,两组比较差异有统计学意义(P<0.05);近期(4周)存活率,治疗组明显高于对照组,分别为71.08%和42.05%,两组比较差异有统计学意义(P<0.01)。结论人工肝支持系统是目前较为成熟的肝脏替代疗法,PE治疗能使慢性重症肝炎相应生化指标好转,对早、中期疗效较好。是治疗重型肝炎安全、有效的措施之一。

Objective To evaluate the efficacy and opportunity and the safety of artificial liver-plasma exchange in patients with chronic severe hepatitis. Methods To choose 83 cases of the chronic severe hepatitis, comparing the main changes of the laboratory taxget before and after the treatment. 80 patients who were not treated with plasma-exchange （PE ） were used as contracting group. The aim is to compare the effectiveness, total effectiveness and recent living rate on the different period. Results There were an improvement of the symptoms, spirit, appetite and bedy-building. And there were significant differences of serum levels of ALT、AST、TBil、 DBil、 PT、 PTA between before and after ALSS therapy in the treatment group. The improvement rates of early and middle period patients in ALSS treatment group were 87.10 % and 69.70% . and the total effectiveness rate was 63.86 %. Comparing with the former, the results of control group were 51.85 %, 38.71% and 37.50 %, respectively. There were significant differences between the two groups, respectively （ P 〈 0. 05 ）. At the recent living rate（four weeks）, the treatment group is absolutely higher than the contracting group. The results were 71.08 % and 42.05 % respectively. There were significant differences between the two groups, respectively （ P 〈 0. 01 ）. Conclusions ALSS treatment can improve the biochemistry of patients suffering from severe hepatitis. It is more suitable to use PE in early and middle＇stage of chronic severe hepatitis. Artificial liver supporting system is the comparatively mature liver replace therapy until now. It＇s also one of the safe and effective measures to treat the severe hepatitis.