血浆胆红素吸附在高胆红素血症治疗中的应用

Application of plasma absorption on patients with hyperbilirubinemia

目的探讨血浆胆红素吸附治疗高胆红素血症疗效及临床价值。方法选择青岛市传染病医院65例非乙型、丙型肝炎急性肝损害重度黄疸住院治疗患者,随机分为2组。治疗组33例,其中男性25例,女性8例,年龄33～75岁,平均年龄59.39岁;对照组32例,其中男性26例,女性6例,年龄34～77岁,平均年龄58.12岁。对照组32例患者只给予药物综合治疗,治疗组33例患者在药物综合治疗的基础上给予血浆特异性胆红素吸附治疗,并分别观察2组治疗前后症状、体征、肝功能、凝血酶原活性(PTA)、血常规、电解质及治疗中并发症的发生。检测治疗前和治疗后2、4周的肝功能、PTA等并追踪近期转归。结果治疗组经血浆胆红素吸附治疗后2周、4周较治疗前,总胆红素(TBiL)下降明显(P<0.01),PTA上升明显(P<0.05)。治疗组4周治愈率39.40%,对照组4周治愈率12.50%(P<0.05),治疗组8周治愈率66.67%,对照组8周治愈率40.63%(P<0.05)。结论血浆胆红素吸附治疗急性肝损害重度黄疸患者能显著改善肝功能,阻止病情恶化,明显提高临床治愈好转率,特别适合于不宜血浆置换治疗的重度黄疸患者。

Objective To study the therapeutic effect of plasma absorption on patients treated with hyperbilirubinemia.Methods A total of 65 hospitalized patients with acute liver injury severe jaundice but non-hepatitis B and non-hepatitis C were enrolled,which were divided into 2 groups randomly.Thirty-three patients in treatment group,male 25,female 8,aged 33-75 years old,mean age 59.39 years old.Thirty-two patients in control group,male 26,female 6,aged 34-77 years old,mean age 58.12 years old.The control group received conventional therapy only,and treatment group was treated with plasma absorption on the basis of conventional therapy.The main symptoms,signs,liver function,prothrombin activity（PTA）,blood count,electrolytes,and complications in treatment of 2 groups were observed.The liver function and PTA of before treatment,2-week,4-week after treatment were examined.Results After treated with plasma absorption,the patients＇ liver function were ameliorated.The PTA in 2-week and 4-week after treatment was increased significantly（P 0.05）,and the level of total bilirubin was decreased obviously（P 0.01）.The total effective rate after 4-week in treatment and control group was 39.40 % and 12.50 % respectively,there were significant differences between 2 groups（P 0.05）.The total effective rate after 8-week in treatment group was 66.67 %,and 40.63 % in control group（P 0.05）.Conclusion It is demonstrated that the liver function of patients with hyperbilirubinemia could be significantly improved by plasma absorption,which could prevent disease progression,and significantly improve the clinical cure rate.It is particularly suitable for unfitting plasma exchange treatment patients.