1013例重型病毒性肝炎疗效分析

A COMPARATIVE AND ALYSIS OF BASIC VS. SYNTHETIC PROCEDURES IN THE TREATMENT OF SEVERE VIRAL HEPATITIS

目的 探讨重型病毒性肝炎新的综合性治疗方案,提高其存活率。方法 分析近20年收治的1013例各型重型肝炎疗效。结果 第一阶段基础治疗为主的109例,存活率为30.3％(33/109);第二阶段在综合治疗的基础上,加用胎肝细胞悬液或注射用促肝细胞生长素,近两年又并用人工肝血液净化治疗,共904例,存活率71.13％(643/904)。两组比较其存活率有明显差异(P<0.001)。1013例重型病毒性肝炎中,急性、亚急性重型肝炎214例—(21.13％),慢性重型肝炎799例—(78.87％)。按入院时病程早、中、晚三期统计,病程早期接受治疗者440例,存活率87.27％(384/440),中期404期,存活率64.85％(264/404),晚期169例,存活率17.75％(30/169)。早期、中期与晚期比较,有显著差异(P<0.001)。研究发现,血清总胆红素高于500μmol/L者,存活率明显降低。结论 重型病毒性肝炎须早期诊断,早期联合细胞因子治疗,以阻断免疫病理对肝细胞的损伤;中期最好能配合人工肝血液净化治疗。在治疗过程中应积极预防和治疗并发症,是提高存活率的关键。

Objective To assess the effect of synthetic procedures in the treatment of severe viral hepatitis for increasing survival rate. Methods The curative effect of different procedures were analysed on the 1013 cases of severe viral hepatitis which had undergone the treatment in hospital in recent twenty years. The treatment procedures had been classified as basic and synthetic (on the basis of basic procedures, using embryonic liver cell suspend liquid or hepatic growth factor,or/and using artificial liver as blood cleaner)ones. Results The survival rate by basic procedures was 30. 03%(33/109)in 109 cases and 71. 13%(643/904)in 904 cases by synthetic procedures. There was obvious statistic difference in survival rate between these two groups (P<0. 001) .Among the patients,24 cases (21.13%) were acute and subacute severe hepatitis,799 cases (78. 87%) were chronic severe hepatitis. 440 cases started their treatment in the early stage course of the disease and the survival rate was 87. 27% (384/440); cases started to be treated in the middle stage of the course and 169 cases in the late stage,the survival rate were 64. 85%(262/404) and 17. 75%(30/169),respectively. There were great significant changes in survival rate according to the time the patients started to be treated during the course of the disease. The survival rate was much lower among the patients when their serum bilirubin was higher than 500μ mol/L. Conclusion Synthetic procedures are effective to increase the survival rate of the patients with severe viral hepatitis. The earlier treatment for the patients starts,the better for the patients of survival.