血浆置换治疗104例慢性乙型重型肝炎的临床疗效分析与评价

Clinical Efficacy and Evaluation of Plasma Exchange Therapy on 104 Cases with Chronic Severe Hepatitis B

目的:了解评价血浆置换(PE)治疗慢性乙型重型肝炎的临床疗效及价值。方法:观察重型肝炎患者PE前后总胆红素、白蛋白5项指标及乏力、腹胀等临床症状变化,比较治疗组和对照组治疗后好转率的差异。统计分析PE治疗及次数与患者预后的关系。检测部分患者PE前后内毒素(LPS)浓度,探讨LPS与患者预后的关系。结果:治疗组和对照组早中期患者好转率分别为54.4%和27.8%(P<0.01);晚期患者的好转率分别为8.3%和1.4%(P>0.05)。PE治疗2到4次,患者的好转率分别为39.4%、43.6%和42.9%,但PE次数在不同组别患者的好转率之间差异无统计学意义(P>0.05)。PE治疗后好转患者血清内毒素浓度下降(P<0.01)。结论:PE能明显改善患者肝功能指标,提高早中期患者的好转率。PE次数为2到4次时,患者的好转率较高,但不同的PE次数未显示相应患者的临床转归之间有统计学意义的差异。血清LPS浓度与患者预后有相关性,治疗前血清LPS浓度低且治疗后下降者,预后较好;相反,治疗前血清LPS浓度高且治疗后下降不明显者,预后较差。

Objective： In order to evaluation the efficacy and affecting factors during the therapy of plasma exchange （PE） treatment on chronic severe hepatitis B, liver function index.times of PE serum.endotoxin lever, ere were discussed separately. Methods： Difference outcomes between different times of PE treatment were also analysed at the same time. Furthermore, 27 cases from therapy group were serily tested for serum endotoxin level before and after PE therapy and the results were compared depending on the patients outcome. Results： The improvement rate of forepat and middle stage cases in the therapy group and control group were 54.4% and 27.8% respectively, while the results of late stage were 8.3 % and 1.4 %. Improvement rate of cases with different times from 2 to 4 of PE treatment were 39.4%,43.6% and 42.9% respectively, with no statistical difference （P〉0.05）. On the other hand, remarkable improvement about serum endotoxin level had been observed after PE treatment. Conclusion： PE therapy could obviously improve liver function index. No statistic meaning had been observed between different times of PE therapy. It was found in this study that Serum endotoxin level was original lower or falling down after PE treatment in some cases would have some better prognosis, while reversely, the prognosis would be much worse.