人工肝血浆置换治疗乙型重型肝炎时病毒负荷量的变化及其临床研究

Changes in Viral Load in Treatment of Severe Hepatitis B with Artificial Liver Plasma Exchange and Its Clinical Significance

目的探讨人工肝血浆置换治疗乙型重型肝炎患者的效果及治疗前后乙型肝炎病毒负荷量的变化。方法 136例乙型重型肝炎按随机数字表法分为观察组76例和对照组60例,2组均给予卧床休息、综合护肝、促进肝细胞再生、支持治疗等,未应用抗病毒治疗。观察组在对照组基础上给予人工肝血浆置换治疗。观察2组治疗前后患者的症状、体征的变化,比较2组的存活率;比较观察组治疗前后主要肝功能指标[总胆红素(TBIL)、直接胆红素(DBIL)、白蛋白(ALB)、胆碱脂酶(CHE)、凝血酶原活动度(PTA)]、细胞因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、内毒素(LPS)及乙型肝炎病毒负荷量(HBV-DNA)水平。结果观察组76例中,53例好转,23例死亡,存活率69.7%;对照组60例中,28例好转,32例死亡,存活率46.6%。2组存活率比较差异有统计学意义(P<0.05)。观察组患者人工肝血浆置换治疗后TBIL、TNF-α、IL-6、LPS均明显下降(均P<0.01),PTA、CHE均明显提高(均P<0.01),HBV-DNA由(7.62±1.68)×107 copies.mL-1下降到(4.75±1.35)×104 copies.mL-1(P<0.01)。结论人工肝血浆置换对乙型重型肝炎患者有肯定的治疗作用,能快速清除乙型肝炎病毒负荷量和蓄积的毒性,提高患者的存活率。

Objective To investigate the changes in hepatitis B viral load in patients treated with artificial liver plasma exchange and its clinical significance.Methods A total of 136 patients were randomly divided into observation group（n=76） and control group（n=60）.All patients were given comprehensive medical treatment,including bed rest,comprehensive liver protection,promotion of hepatocyte proliferation,and support treatment.The observation group was given additional treatment with artificial liver plasma exchange.The indicators of liver function（TBIL,DBIL,ALB,CHE and PTA）,TNF-α,IL-6,LPS,HBV-DNA,symptoms and signs were observed before and after artificial liver support.The survival rate was compared between the two groups.Results In observation group,clinical improvement occurred in 53 patients and death in 23 patients.In control group,clinical improvement occurred in 28 patients and death in 32 patients.The survival rate in observation group was significantly higher than that in control group（69.7% vs 46.6%,P0.05）.After treatment with artificial liver plasma exchange,TBIL,TNF-α,IL-6 and LPS markedly decreased（P0.01）,PTA and CHE significantly increased（P0.01）,and HBV-DNA declined from（7.62±1.68）×107 copies·mL-1 to（4.75±1.35）×104 copies·mL-1（P0.01）.Conclusion Artificial liver plasma exchange has a positive impact on severe hepatitis B.It can alleviate hepatitis B viral load and accumulated toxicity and thus increase survival rate among patients with severe hepatitis B.