血浆吸附灌流联合血浆置换治疗肝衰竭和高胆红素血症的临床研究

Combination therapy of plasma perfusion and plasma exchange in patients with liver failure and hyperbilirubinemia

目的观察血浆吸附灌流(plasma perfusion,PP)联合血浆置换(plasma exchange,PE)的组合型人工肝方法治疗肝衰竭和高胆红素血症的临床疗效。方法将PP和使用少量血浆的PE联合在1次治疗模式(联合组)中完成,治疗51例66例次肝衰竭和高胆红素血症患者,检测治疗前、结束时及治疗结束48h时患者血总胆红素、总胆汁酸、PTA、ALB及WBC水平,并观察不良反应发生情况,与同期进行的36例79例次单纯PE治疗患者(PE组)做对照。结果①联合组治疗的总有效率为60.87%,高于PE组的52.78%,但差异无统计学意义(P>0.05);②2组患者治疗结束及治疗结束48h时血清总胆红素均明显低于治疗前水平(P<0.05),联合组治疗结束时血清总胆红素下降幅度高于PE组(P<0.05);③2组患者治疗结束时血清总胆汁酸均低于治疗前水平(P<0.05),但2组间比较差异无统计学意义(P>0.05);④2组治疗结束时PTA值均高于治疗前水平(P<0.05);⑤同治疗前比较,联合组治疗结束时及治疗结束48h时血清ALB、GLO均无明显变化(P>0.05),而PE组则明显减少(P均<0.05);⑥同治疗前比,2组治疗结束时及治疗结束48h时血WBC总数均无明显变化(P>0.05),2组治疗结束时血PLT总数均明显减少(P均<0.05);⑦联合组平均使用血浆量明显少于PE组;⑧未发生严重不良反应。结论本研究建立的PP联合PE的人工肝方法血浆用量少,治疗肝衰竭和高胆红素血症安全有效。

Objects To evaluate the therapeutic efficacy of combination therapy of plasma perfusion （PP） and plasma exchange （PE） on patients with liver failure and hyperbiliruhinemia. Methods Fifty-one patients （totally 66 person-times） with liver failure and hyperbilirubinemia received a combination therapy of PP and PE with a small amount of plasma. Serum TBIL, TBA, PTA, ALB and WBC were measured before treatment, at the end of treatment and at hour 48 post-treatment. Adverse reactions were closely observed. Thirty-six patients （totally 79 person-times） who simply received PE were taken as the control group. Results The total effective rate of combination therapy group was 60.87%, higher than that of PE group （52.78%）, but the difference was not statistically significant between both groups （P 〉0.05）. Serum TBIL levels at the end of treatment and at hour 48 post-treatment were significantly lower than those before treatment in the patients of both groups （P〈 0.05）, and the levels decreased more sharply in the patients of the combination therapy group than in the patients of PE group （P〈0.05）. The serum levels of TBA in the patients of both groups were lower at the end of treatment than those before treatment（P〈0.05）, but no significant differences were found between both groups （P 〉0.05）. PTA values of the patients of both groups were higher at the end of treatment than before treatment （P〈0.05）. Compared with pretherapy, serum ALB and GLO levels in the patients of combination therapy group made no differences at the end of treatment and at hour 48 post-treatment, but those in the patients of PE group decreased significantly（P〈0.05）. Compared with pretherapy, there were no differences in WBC counts in the patients of both groups at the end of treatment and at hour 48 post-treatment, but PLT counts in the patients of both groups decreased significantly at the end of treatment （P〈0.05）. The average usage of plasma among the patients of combination therapy group was significantly lower than that among the patients of PE group. No severe adverse reactions were observed. Conclusion The combination therapy of PP and PE uses a smaller amount of plasma, and is safe and effective for the patients with liver failure and hyperbilirubinemia.