重症肝炎患者血浆置换治疗的临床疗效观察

Curative effect of plasma exchange in the treatment of patients with severe hepatitis

目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者的凝血酶原时间(PT)、凝血酶时间(TT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(T-BILI)、直接胆红素(D-BILI)和总胆汁酸(TBA)等生化指标的变化;同时观察2组患者的临床症状及体征的改变,评价整体疗效,并在统计分析患者病情分期、并发症与血浆置换治疗重型肝炎疗效的关系后,做出临床评判。结果 1)PE组治疗前后凝血功能和肝功能生化指标分别为:PT(s)24.5±9.19 vs17.8±6.71、TT(s)16.6±3.87 vs 17.9±11.82、ALT(U/L)281.2±271.16 vs 69.4±91.97、AST(U/L)285.8±247.91vs 64.8±43.94、T-BILI(μmol/L)407.0±178.99 vs 238.2±143.76、D-BILI(μmol/L)316.1±131.09 vs 167.4±110.85、TBA(μmol/L)141.7±83.56 vs 140.6±86.26;2)总体有效率(%),PE与对照组为56.41 vs 30.00,其中早、中、晚期的重型肝炎有效率分别为81.25 vs 41.67、53.85 vs 40.00、20.00 vs 12.50(P<0.05);3)并发自发性腹膜炎的患者治疗后的有效率(%),PE与对照组分别为70.00 vs 40.00。结论 PE是治疗重型肝炎的1种安全、有效方法;对于早期重症肝炎患者疗效优于中晚期重症肝炎患者,对合并自发性腹膜炎患者的疗效优于单纯内科综合疗法。

Objective To investigate the effect of plasma exchange（ PE）,a kind of artificial liver support system（ ALSS）,and the change of blood biochemical indexes in the treatment of severe hepatitis,to observe the relations between prognoses of the patients treated with plasma exchange and their complications from severe hepatitis,to evaluate the safety of plasma exchange for treating severe hepatitis. Methods Clinical data on 69 patients with severe hepatitis were analyzed. On the basis of different therapies,these patients were divided into two groups： PE group and control group. The PE group used plasma exchange based on conventional indication,while the control group only used a comprehensive set of medication. Before the treatment and 24 hours after plasma exchange,the blood of the patients were taken to test the changes of patients＇ serum level in biochemical indices,such as PT,TT,ALT,AST,T-BILI,D-BILI,TBA,etc. Clinical symptoms and signs were observed. The efficiency of plasma exchange at different stage of severe hepatitis was analyzed. The effect of gender,biochemical parameters and complication from severe hepatitis was evaluated by univariate analysis. Results The clinical symptoms and signs of the patients in the experimental group improved significantly after plasma exchange. When comparing the experimental group and control group,coagulation function and liver function tests also improved： PT（ s） 24. 5 ± 9. 19 vs.17. 8 ± 6. 71,TT（ s） 16. 6 ± 3. 87 vs 17. 9 ± 11. 82,ALT（ g / L） 281. 2 ± 271. 16 vs 69. 4 ± 91. 97,AST（ g / L） 285. 8 ±247. 91 vs 64. 8 ± 43. 94,T-BILI（ μmol / L） 407. 0 ± 178. 99 vs 238. 2 ± 143. 76,D-BILI（ μmol / L） 316. 1 ± 131. 09 vs 167. 4± 110. 85,TBA（ μmol / L） 141. 7 ± 83. 56 vs 140. 6 ± 86. 26. The overall desirable outcome of PE group was 56. 41%,of which the efficiencies of treatment in early,middle and late severe hepatitis were 81. 25%,53. 85%,and 20. 00%,respectively. In the control group,only 30. 00% achieved desirable outcome,of which the efficiencies in early,middle,late severe hepatitis were 41. 67%,40. 00%,12. 50%（ P〈0. 05）.In PE group, the desirable outcome after treatment in the patients with spontaneous bacterial peritonitis was 70. 00%,while in the control group,the desirable outcome was 40. 00%.Conclusion Plasma exchange is an effective method to treat severe hepatitis. It is more effective in the early stage of liver failure,but not as much in the late stage. The efficiency of treatment on patients with spontaneous bacterial peritonitis in the PE group was better than the control group.