血必净治疗重症乙型肝炎患者血浆D-二聚体的变化

Changes of Plasma D-Dimer after the Treatment with Xuebi Jing Injection in Severe Hepatitis B Patients

目的研究血浆D-二聚体(D-D)检测对重症乙型肝炎患者的早期预警和疗效评估的作用。方法将重症乙型肝炎患者38例随机分为两组,对照组18例,内科综合治疗;治疗组20例,在内科综合治疗基础上加用血必净50ml/d加入0.9%氯化钠注射液100ml静脉滴注,检测两组患者治疗前及治疗后第7,14天的血浆D-D浓度,观察两组患者血浆D-D的变化及转归。结果重症乙型肝炎患者血浆D-D阳性率71.1%,血浆D-D水平(3.09±1.01)mg/L。血必净治疗组和对照组较治疗前D-D水平降低;第7天治疗组D-D较对照组减少更明显,差异具有统计学意义(P<0.05);治疗第14天,治疗组D-D较对照组降低进一步明显,差异有统计学意义(P<0.01)。治疗组病死率(15.0%)与对照组(44.4%)比较,差异有统计学意义(P<0.05)。结论重症乙型肝炎患者D-D阳性率高,D-D水平升高与肝炎病情加重有关,凝血反应可能参与了重症乙型肝炎患者的病理过程。血必净治疗可明显下调血浆D-D的表达,改善重症乙型肝炎患者的预后。动态监测D-D对重症乙型肝炎患者有预警作用,可作为评估疗效的指标之一。

Objective To investigate the effect of the detection of plasma D-dimer（D-D） on premonitory signs and disease assessment of deterioration of patients suffering from severe hepatitis B.Methods 38 severe hepatitis B patients were randomly divided into routine treatment group（n=18） and Xuebi Jing treatment group（n=20）.Both groups were given comprehensive medical treatment,while the Xuebi Jing treatment group was given Xuebi Jing infusion in addition,with 50 ml/d in 0.9% sodium chloride injection 100 ml.The concentrations of plasma D-D were detected before and after the treatment of 7,14 days.The changes and the treatment outcomes of plasma D-D were observed in both groups.Results The positive rate of plasma D-D of severe hepatitis B group was 71.1%,the plasma D-D levels of severe hepatitis B group was （3.09±1.01）mg/L.The plasma D-D levels of XueBi Jing treatment group and routine treatment group were reduced obviously after the treatment;The D-D after the first 7 days and 14 days treatment was reduced significantly（P0.05,or P0.01）.Compared with that（44.4%） of routine treatment group,the death rate（15%） of Xuebi Jing treatment group was statistically different（P0.05）.Conclusion The positive rate of plasma D-D was found high in patients of severe hepatitis B.The increasing of D-D may correlate with the severity of patient’s condition.The coagulation response may be involved in the process of deterioration of hepatitis B.XueBi Jing treatment can significantly reduce the expression of plasma D-D and improve the prognosis.Dynamic detection of plasma D-D had the effect on premonition with the patients suffering from deteriorate hepatitis B and can serve as one of the indicators for assessing the treatment efficacy.