持续缓慢选择性与单纯血浆置换治疗高胆红素血症

Continous and part plasma exchange and single plasma exchange in the treatment of patients with hyperbilirubinemia

目的探讨持续缓慢选择性血浆置换(CPPE)和单纯血浆置换(SPE)治疗高胆红素血症的临床疗效。方法分析71例(139例次)接受CPPE的患者(CPPE组)治疗前、治疗结束时及治疗后48h时血清清蛋白(ALB)、球蛋白(GLO)、凝血酶原活动度(PTA)及总胆红素(TBIL)的变化情况,并与36例(79例次)接受SPE的患者(SPE组)做比较。结果①同治疗前相比,2组患者治疗结束时及治疗结束48h时血PTA值均明显升高(P均<0.01),但2组间比较差异无统计学意义(P>0.05);②同治疗前比较,CPPE组治疗结束时及治疗后48h时血清ALB、GLO差异均无统计学意义(P>0.05),而SPE组则明显减少(P均<0.01);③同治疗前比较,2组治疗结束时TBIL下降幅度差异无统计学意义(P>0.05),但同治疗结束时比,CPPE组治疗结束48h时血TBIL上升幅度为22.91%±12.50%,而SPE组为39.30%±25.42%,差异有统计学意义(P<0.05);④CPPE组患者临床治愈好转率为59.16%(42/71),高于SPE组的38.89%(14/36),差异有统计学意义(χ2=3.933,P<0.05)。结论CPPE治疗高胆红素血症时,可减少新鲜冰冻血浆的用量,减少血清ALB、GLO、纤维蛋白原及凝血因子等有益物质的丢失,延缓治疗后血清TBIL反弹的幅度和速度,提高高胆红素血症患者临床治愈好转率。因此,CPPE是治疗高胆红素血症有效且安全的方法。

Objective To explore the effects of continous and part plasma exchange （CPPE） and single plasma exchange （SPE） on patients with hyperbilirubinemia. Methods The levels of albumin, globin, PTA and TBIL in the sera of 71 patients in CPPE group before treatment, at the end of treatment and 48 hours after treatment were analyzed and compared with those of 36 patients in SPE group. Results The levels of serum PTA of the two groups at the end of treatment and 48 hours after treatment were obviously higher than those before treatment （P〈0.01）, but the difference was not statistically significant （P〉0.05）. Compared with pretherapy, there were no differences in the levels of serum albumin and globin in CPPE group at the end of treatment and 48 hours after treatment （P〉0.05）, but the levels of serum albumin and globin decreased obviously in SPE group （P〈0.01）. Compared with pretherapy, the levels of serum TBIL decreased in both groups at the end of treatment, with no statistical difference, but compared with those at the end of treatment, TBIL levels increased by 22.91% ± 12.50% in CPPE group and by 39.30% ± 25.42% in SPE group at 48 hours after treatment （P〈0.05）. The curative rate in CPPE group was 59.16%, much higher than that in SPE group（38.89%）, with statistical difference（ X^2=3.933 ,P〈0.05）. Conclusions The treatment of hyperbilirubinemia by CPPE is relatively safe and effective, for it can reduce the usage of the fresh frozen plasma, prevent the loss of serum albumin, globin and blood coagulation factor, delay rebouncing of the level of serum TBIL and improve the survival rate of patients with hyperbilirubinemia.