血浆置换治疗伴高胆红素血症的戊型肝炎患者临床疗效初步研究

Clinical efficacy of plasma exchange in treatment of patients with hepatitis E and hyperbilirubinemia

目的探讨行血浆置换(PE)治疗淤胆型戊型肝炎患者的临床疗效。方法 61例淤胆型戊型肝炎患者被随机分为对照组(n=32)和治疗组(n=29)。对照组患者仅接受内科综合治疗,治疗组患者在内科综合治疗的基础上,同时给予血浆置换治疗,观察两组治疗前后AST、GGT、TBIL、DBIL、ALB、TP、BUN、Cr、TBA、ALP指标变化及预后。结果治疗4周后,治疗组患者有效率达到96.6%,显著高于对照组的62.5%(P<0.05);治疗组患者血清TBIL、AST和GGT水平分别为(73.4±52.)μmol/L、(75.9±58.4)U/L和(48.6±19.0)U/L,均显著低于对照组的【(166.3±81.2.)μmol/L、(147.8±47.0)U/L和(150.8±68.5)U/L,P<0.05】;两组患者肾功能指标无显著变化;在治疗期间,治疗组所有患者均完成治疗,无死亡病例,而对照组有2例放弃治疗,自动出院,另死亡1例;在107次血浆置换治疗过程中,9例次出现过敏性反应,1例出现血压下降,对症处理后恢复。结论血浆置换是一种有效的人工肝支持系统,能够较快地改善淤胆型戊型肝炎患者的临床症状和高胆红素血症,对后续治疗起到关键作用。

Objective To investigate the clinical efficacy of plasma exchange in treatment of patients with hepatitis E and hyperbilirubinemia. Methods 61 patients with hepatitis E and hyperbilirubinemia were recruited in this study between February 2011 and May 2016,and the patients were divided into two group,with 32 cases receiving conventional treatment and 29 cases receiving plasma exchange （PE） at the base of conventional therapy. The clinical symptoms and serum parameters were measured. Results At the end of four week treatment,the total efficient rate in the PE-treated group was 96.6%,much higher than 62.5% （P〈0.05） in the control;serum bilirubin,alanine aminotrasferase and gamma glutamyl transferas levels in the PE group were （73.4±52.）μmol/L, （75.9±58.4） U/L and （48.6±19.0） U/L,much lower than in the control[（166.3±81.2.）μmol/L,（147.8±47.0） U/L and （150.8±68.5） U/L,respectively,P〈0.05];serum renal function tests in the two groups were not significantly changed;all patients completed the PE procedure and survived without death,while three patients in the control died;the side effect including 9 allergic reaction and one hypotension occurred during PE,and all disappeared with appropriate management. Conclusions PE can remarkably decrease blood bilirumin levels and improve clinical symptoms,which might give the chance for further intervention for patients with hepatitis E and hyperbilirubinemia.