人工肝血浆置换治疗慢性乙型重型肝炎51例临床分析

51 cases of clinic analysis of artificial liver plasma exchange in the treatment of chronic severe hepatitis B.

目的探讨人工肝血浆置换治疗慢性乙型重型肝炎的疗效。方法对51例慢性乙型重型肝炎患者进行常规的内科治疗基础上给予人工肝血浆置换117次,比较人工肝血浆置换前后患者临床症状、肝功能、凝血功能等指标和对生存率的影响。结果人工肝血浆置换后,患者临床症状均有不同程度的改善。血浆总胆红素、直接胆红素、丙氨酸转氨酶、天门冬氨酸转氨酶较人工肝血浆置换前明显降低(P<0.01或P<0.05),PTA上升(P<0.05)。早期重型肝炎24例存活22例(91.67%),中期重型肝炎17例中存活12例(70.59%),晚期重型肝炎10例存活3例(30%)。不良反应较轻,经对症处理后均消失。结论人工肝血浆置换治疗慢性乙型重型肝炎可明显改善患者的临床症状及生化指标。人工肝血浆置换对早、中期慢性乙型重型肝炎疗效较好,对晚期慢性乙型重型肝炎疗效较差,宜早期进行人工肝血浆置换,提高慢性乙型重型肝炎患者的生存率。

Objective To observe the therapeutic effect of artificial liver plasma exchange in the treatment of chronic severe hepatitis B. Methods 51 cases of chronic hepatitis B patients with routine medical treatment add artificial liver plasma exchange 117 times, compared with clinical symptoms, liver function, blood coagulation function, and the impact on the survival rate before and after the artificial liver plasma exchange. Results the clinical symptoms in patients with varying degrees of improvement after the artificial liver plasma. The plasma total bilirubin, direct bilirubin, alanine aminotransferase and aspartate aminotransferase are significantly lower after the artificial liver plasma exchange （P 〈0.01 or P 〈0. 05）, PTA increased （P 〈0.05）. 22 cases of severe hepatitis early survive in the 24 cases （91.67%）, 12 cases of severe hepatitis medium-term survive in the 17 cases （70.59%）. 3 cases of severe hepatitis late survive in the 10 cases （30%）. Side effects is less, the symptoms disappear after all. Conclusions artificial liver plasma exchange treatment of chronic hepatitis B patients can improve clinical symptoms and biochemical markers. The effects of artificial liver plasma exchange on chronic severe hepatitis B early and medium-term are better than chronic severe hepatitis B late. The artificial liver plasma exchange should be carried out as soon as possible, that improve the chronic henatitis B natients survival rate.