多次血浆置换治疗63例(160次)重型乙型肝炎临床分析

Clinical Analysis on Treatment of 63 Patients Suffered from Severe Hepatitis B with Multiple Plasma Exchange

目的探讨多次血浆置换治疗重型乙型肝炎的临床效果。方法对63例重型乙型肝炎患者反复进行血浆置换治疗,比较置换前后患者症状、总胆红素(TBIL)、凝血酶原活动度(PTA)的变化和有效好转率。结果治疗后患者症状明显减轻,TBIL、PTA均有不同程度的改善,治疗前后TBIL分别为(429.56±143.65)μmol/L和(268.93±92.86)μmol/L,治疗前后PTA分别为(31.94±12.02)%和(52.36±12.15)%。63例患者中28例好转,35例无效(包括肝移植或死亡),好转组TBIL、PTA在治疗结束第3dTBIL反弹幅度均较无效组差异有统计学意义(P<0.05),治疗好转组患者在结束治疗第3dTBIL反弹至原来水平的(0.78±0.23),而无效组反弹至原来水平的(0.98±0.19),治疗好转组患者在结束治疗第3dPTA能保持在血浆置换后(0.81±0.23),而无效组为(0.58±0.19)。同时在多次血浆置换中治疗好转组TBIL平均数值呈现逐步下降趋势,而无效组显示无明显下降。结论人工肝血浆置换能显著改善患者临床症状及生化指标,监测TBIL及PTA的变化有助于决定是否多次行血浆置换治疗。

Objective To investigate the therapeutic effects on patients suffered from severe hepatitis B with multiple plasma exchange （PE）. Methods Sixty - three patients with severe hepatitis B received 160 times of treatment with multiple plasma exchange; the patient＇s symptoms, serum total bilirubin （TBil）, prothrombin activity （PTA） and improvement rate were compared before and after PE. Results The patient＇s symptoms lessened significantly, serum total bilirubins and PTA were improved on different level. Before and after PE, the levels of serum total bilirubins were 429.56 ± 143.65 μmol/L and 268.93 ± 92.86 μmol/L, prothrombin activities were 31.94 ± 12.02 % and 52.36 ± 12. 15 % respectively. There were 28 cases improved in 63 patients with severe hepatitis B, and 35 cases were invalid. The level of TBil in the patients of improved group rebounded less than those in the patients of invalid group （0.78 ± 0.23 vs 0.98 ± 0.19 ; P〈 0.05）. After several times of plasma exchange, the level of TBil in the patients of improved group decreased gradually, but the invalid group had not. Conclusions Plasma exchange can significantly improve the clinical symptoms and biochemical indicators, monitoring of serum total bilirubins and prothrombin activity can make for if the several times of PE are treated on patients with severe hepatitis B.