血浆置换联合血浆吸附治疗慢性重型肝炎的临床研究

Clinical research of plasma exchange combined with plasma adsorption in the treatment of chronic severe hepatitis

目的探讨血浆置换(PE)联合血浆吸附(PA)与单纯PE治疗慢性重型肝炎的效果。方法 97例慢性重型肝炎患者,随机分为治疗组(51例)与对照组(46例),治疗组在普通保肝、对症治疗基础上给予PE+PA联合治疗,对照组在保肝、对症治疗基础上给予单纯PE治疗,观察两组治疗前后的症状、体征、化验指标、治疗效果及不良反应情况。结果两组患者经治疗后大部分精神、食欲好转,乏力、腹胀等症状及皮肤黏膜黄染明显减轻;治疗组及对照组治疗后总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总蛋白(TP)、白蛋白(ALB)、胆碱酯酶(CHE)、血氨(NH_3)、凝血酶原活动度(PTA)、内毒素(LPS)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素Ⅱ受体(s IL-2R)较治疗前均有明显好转(P<0.01或P<0.05),且治疗后治疗组TBIL、ALT、AST、NH_3、PTA、LPS、TNF-α、IL-6、s IL-2R优于对照组(P<0.01或P<0.05)。追踪观察12周,治疗组好转率高于对照组(P<0.05)。结论 PE+PA治疗慢性重型肝炎能显著改善肝功能,提高存活率。

Objective To investigate effects by plasma exchange（PE） combined with plasma adsorption（PA） and single PE in the treatment of chronic severe hepatitis. Methods A total of 97 patients with chronic severe hepatitis were randomly divided into treatment group（51 cases） and control group（46 cases）. The treatment group received additional PE＋PA treatment to general liver protection and symptomatic treatment. The control group received additional PE treatment to general liver protection and symptomatic treatment. Observation was made on symptoms, vital signs, laboratorial indexes, curative effects and adverse reactions before and after treatment of the two groups. Results After treatment, both groups had mainly improved mind and appetite, and obviously reduced weak, abdominal distension symptoms, and skin mucous membrane yellowing. Comparing with those before treatment, the treatment group and the control group had obviously improved total bilirubin（TBIL）, alanine transaminase（ALT）, aspartate aminotransferase（AST）, total protein（TP）, albumin（ALB）, cholinesterase（CHE）, blood ammonia（NH_3）, prothrombin activity（PTA）, endotoxin（LPS）, tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6） and soluble interleukin Ⅱ receptor（s IL-2R） after treatment（P〈0.01 or P〈0.05）. After treatment, the treatment group had all better TBIL, ALT, AST, NH_3, PTA, LPS, TNF-α IL-6 and s IL-2R than the control group（P〈0.01 or P〈0.05）. Follow-up lasted for 12 weeks, and the treatment group had higher improvement rate than the control group（P〈0.05）. Conclusion PE＋PA treatment can remarkably improve liver function and increase survival rate in chronic severe hepatitis patients.