血浆置换治疗重型肝炎的临床观察

Clinical observation of plasma exchange in treatment of severe hepatitis

目的观察血浆置换(PE)治疗重型肝炎的临床疗效及影响效果的主要因素。方法随机抽取符合病例选择标准的40例患者为治疗组,36例为对照组,两组内科综合治疗相同,治疗组加PE治疗。通过观察两组患者治疗前后临床症状、生化指标等的变化及出院后6个月随访,判断PE的疗效及影响疗效主要因素。结果治疗组治疗后第2、4周ALT、TBIL指标比对照组明显改善(P均<0.01);治疗组急、慢性患者出院时及出院后6个月随访总有效率明显高于对照组(P<0.01或P<0.05);治疗组早、中期患者有效率明显高于对照组(P<0.05);但在晚期,PE治疗组与对照组相比差异无显著性(P>0.05);出现肝性脑病、上消化道出血、肝肾综合征、自发性腹膜炎等并发症时的治疗有效率差异无显著性(P>0.05)。结论PE治疗重型肝炎疗效肯定,肝病严重程度、病期及并发症为影响疗效主要因素,掌握治疗时机是提高疗效的关键。

Objcetive To outline the clinical efficacy of plasma exchange （PE） for patients suffered from gravis hepatitis, and analyze the main factors which affect the outcome. Methods Forty patients were chosen as theraeutic group and thirty - six as control group randomly. Both groups received conventional complex treatment, in addition, the therapeutic group received PE as well. Main clinical symptoms, blood biochemical indices before and after treatment and the outcome of 6 - month follow - up were recorded for judging clinical results and its affected factors. Results The therapeutic group in ALT and TBIL indices improved appreciably than control group 2 and 4 weeks after treatment, there was statistical significant difference （ P 〈 0.01）. Patients with acute or chronic hepatitis in therapeutic group had better efficacy ratio than those in control group at the end of treatment and 6 - month follow -up, there was statistical difference （ P 〈0.01 or P 〈0.05）. Early- or -mid stage patients in the therapeutic group had better efficacy ratio than those in control group （ P 〈0.05）. But for advanced patients, there was no statistical difference in efficacy rate between therapeutic group and control group （ P〉0.05）. The efficacy ratio did not differ between the two groups for patients associated with hepatic encephalopathy, upper gastrointestinal hemor- rhage, hepatorenal syndrome and primary peritonitis （ P 〉 0.05）. Conclusion PE is an effective method for gravis hepatitis, the efficacy of PE is closely associated with types, stage and complication. Treatment timing plays an important role for better efficacy.