两种新型非生物型人工肝治疗慢性乙型重型肝炎疗效观察

Efficacy of two new methods of non-biologic artificial liver in the treatment of chronic severe hepatitis B

目的 探讨两种新型非生物型人工肝，即缓慢性血浆置换（PE）同步并联静脉．静脉血液滤过（CWH）和配对血浆置换滤过吸附（CPEFA）治疗慢性乙型重型肝炎患者的临床疗效。方法130例患者随机分成3组，A组44例，B组43例，C组43例。A组在内科综合治疗基础上加用缓慢性PE同步并联CVVH治疗，B组在内科综合治疗基础上加用CPEFA治疗，C组在内科综合治疗基础上加用单纯PE治疗。观察3组治疗前后临床症状、体征、肝功能指标、血钠浓度及近期有效率、生存率。结果治疗结束时3组中多数患者的症状、体征有不同程度好转，肝功能主要指标明显改善。A、B两组低钠血症改善，近期有效率（治疗后6个月内）分别为70．45％和72．09％，两组间比较差异无统计学意义（X^2=0．10，P〉0．05），6个月生存率分别为45．45％和46．51％，差异无统计学意义（x2=0．08，P〉0．05）；C组低钠血症无改善，近期有效率51．16％，与A、B两组比较，差异有统计学意义（X^2=7．55、9．31，P〈0．01），6个月生存率为30．23％，与A、B两组比较，差异有统计学意义（X^2=4．80、6．10，P〈0．05）。结论缓慢性PE同步并联CVVH和CPEFA是两种新型、安全、有效的非生物型人工肝治疗方法。

Objective To explore the clinical effects of two new treatment methods of non-biologic artificial liver [ slower plasma exchange （PE） combined with continuous veno-venous hemofiltration （CVVH）, and coupled plasma exchange filtration adsorption （CPEFA）] in treatment of chronic severe hepatitis B patients. Methods 130 patients with chronic severe hepatitis B were divided into three groups. 44 patients were treated with a parallel circuit of being combined slower PE and CVVH based on the conservation medical therapy （group A）. 43 patients were treated with CPEFA based on the conservation medical therapy （group B）. 43 patients received PE with conservative medical therapy （group C）. The clinical symptoms, signs, liver function, blood sodium concentration, effective rates and survival rates in three groups were surveyed before and after treatment. Results The symptom and signs of the majority in the above different groups improved. In group A and B, hyponatremia of patients were improved, the effective rates （within 6 months after the treatment） were 70.45% and 72.09% respectiverly. There was no statistical difference between the two groups （ X2 = 0. 10, P 〉 0.05）, the survival rates（6 months） were 45.45% and 46.51% respectively and there was no statisti- cal difference （ X2 = 0.08, P 〉 0.05）. In group C, patients＇ hyponatremia did not change, the effective rate （51.16%） was obviously lower than those in group A and B （ X2 = 7.55,9.31, P 〈 0.01 ） and the total survival rate（6 months） was 30.23 % also lower than those in group A, B （ X2 = 4.80,6.10, P 〈 0.05）. Conclusions Being combined slower PE and CVVH with a parallel circuit and CPEFA are two new, safe and effective methods of non-biologic artificial liver treatment.