终末期肝病模型评分系统对慢性重型肝炎不同血浆量的血浆置换的疗效及预后分析

Plasma exchange treatment using MELD scoring system and different capacity analyzes the curative effect and prognosis of fulminant hepatitis in Chinese patients

目的应用终末期肝病模型（MELD）评分系统预测血浆置换（PE）治疗重型肝炎疗效及预后。方法172例重型肝炎患者随机分为A（2000mL）组、B（3000mL）两组，并设对照组（未PE治疗）。应用终末期肝病模型（MELD）评分系统判断患者（PE）治疗的病死率和治疗前后的临床生化指标进行比较，探讨病情与预后的关系。结果MELD分值在30～39患者PE后两组总胆红素（TBIL）、凝血酶原时间国际标准化比值（INR）、血肌酐（Cr）均明显低于治疗前的水平，差异有统计学意义（P〈0．01）。病死率：A组为48．28％，B组为46．43％，均明显低于对照组（83．33％），差异有统计学意义（P〈0．01）。MELD分≥40的患者PE后的TBIL、INR也明显低于治疗前的水平，差异有统计学意义（P〈0．01），但血清Cr差异无统计学意义（P〉0．05）。病死率A、B组分别为88．89％、82．14％，与对照组96．67％相比，差异无统计学意义（P〉0．05）。结论不同血浆量的血浆置换均可改善肝脏功能，尽早PE治疗可提高患者存活率。

Objective To study the prognosis of patients with fulminant hepatitis after using different capacity in PE treatment plasma exchange treatment using model for end-stage liver disease （MELD）scoring system. Methods One hundred and seventy-two patients with heavy hepatitis were divided into two group, and the relation between the illness state and the prognosis was discussed after comparative study on patients＇ mortality rates by stages and the clinical biochemical indexes before and after the treatment. Results TBIL, INR and Cr levels of MELD score from 30 and 40 sufferer were evidently lower than the levels before the PE treatment and the differences had statistic meaning（P 〈0.01 ）. The patients＇ mortality rates were 48. 28% in group A and 46. 43% in group B, which were lower than the rate 83.33% in the comparison group, and the differences had statistic meaning （P 〈0. 01 ）. But the MELD scores higher than 40 of effect on serum Cr had no statistic meaning （P 〉 0.05） , which may be related to the lack of evidence on the improvement of kidney function resulting from the solitary PE treatment. The mortality rates in the groups with PE treatment were 88.89% in group A and 82.14% in group B respectively, comparing to the rate 96.67% in the comparison group, and the differences on the mortality rates had no statistic meaning （P 〉 0.05）. Conclusion Plasma exchange treatment using different capacity can improve liver function.