人工肝支持治疗戊型肝炎的临床效果

THE EFFICACY OF ARTIFICIAL LIVER SUPPORT SYSTEM FOR HEPATITIS E

目的观察人工肝支持系统(ALSS)治疗戊型肝炎的临床效果。方法应用血浆置换(PE)、血浆灌流(PP)及血液灌流联合血液透析(HP+HD)方法治疗戊型肝炎病人39例,评价疗效并观察治疗前后总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、清蛋白(ALB)、胆固醇(CHOL)、胆汁酸(TBA)、尿素氮(BUN)、肌酐(Cr)及凝血酶原活动度(PTA)的变化。结果ALSS可显著改善病人临床症状,治疗后肝功能明显改善,ALB、PTA较治疗前明显增高,血清TBIL、TBA水平降低(t=2.61～10.11,P<0.01),而对肾功能影响不大。PE、HP+HD和PP治疗对血清TBIL降低无明显影响。重型肝炎治愈好转率老年组低于非老年组(χ2=1.97,P<0.05)。结论ALSS可显著改善戊型肝炎病人临床症状及生化指标,提高治愈率,减少重症肝炎的发生率,特别是对老年戊型肝炎更为重要。

Objective To investigate the clinical effect of artificial liver support system （ALSS） in treating hepatitis E. Methods Thirty-nine patients with hepatitis E were treated by using plasma exchange （PE）, plasma perfusion （PP） and hemoperfusion （HP） plus hemodialysis （HD）. The efficacy was assessed and the changes of serum TBIL, ALT, AST, ALB, CHOL, TBA, BUN, Cr and PTA were measured before and after therapy. Results Clinical symptoms and liver function of the patients improved after treatment. Serum albumin and PTA increased, and serum bilirubin and TBA decreased （t= 2.61- 10. 11, P〈0. 01 ）, renal function was not much affected （P〉0. 05）. This modality of therapy did not markedly influence serum bilirubin level. The cure and improvement rates were better in non-older-age group than in older-age group （χ^2=1.97, P〈0, 05）. Conclusion ALSS can significantly improve the clinical symptoms and biochemical index of patients with hepatitis E, raise the cure rate and reduce the incidence of serious hepatitis, which is especially important for hepatitis E in the elderly.