血浆凝血酶原活动度和血清甲胎蛋白、前白蛋白联合检测在人工肝血浆置换治疗重型肝炎的临床意义

Clinical significance of plasma prothrombin activity and serum alpha-fetoprotein, precursor protein in severe hepatitis patients treated with artificial liver plasma exchange

目的 探讨血浆凝血酶原活动度（PTA）和血清甲胎蛋白（AFP）、前白蛋白（PALB）等生化指标变化在人工肝血浆置换治疗重型肝炎中的临床意义.方法 回顾性分析31例重型肝炎患者的临床资料,均在综合治疗的基础上行人工肝血浆置换治疗,根据患者临床转归分为生存组（17例）和死亡组（14例）.分别于治疗前（入院第2天）,治疗后第3、9、18天及末次（出院前/临终前）检测血浆凝血酶原时间（PT）和血清AFP、PALB,并计算PTA.结果 两组治疗前和治疗第3天PTA比较差异无统计学意义（P〉0.05）;死亡组治疗第9天、治疗第18天和末次PTA明显低于生存组[（30.17±4.79）％比（39.74±4.77）％、（25.47±6.46）％比（42.79±6.88）％和（21.40±9.17）％比（47.17±5.46）％],差异有统计学意义（P〈0.05）.两组治疗前AFP比较差异无统计学意义（P〉0.05）;死亡组治疗第3天、治疗第9天、治疗第18天和末次AFP明显低于生存组[（121.9±31.7）μg/L比（134.6±31.8）μg/L、（88.7±40.8）μg/L比（169.9±41.7）μg/L、（56.9±29.7）μg/L比（176.8±48.1）μg/L和（29.8±15.7）μg/L比（204.3±41.2）μg/L],差异有统计学意义（P〈0.05）.两组治疗前PALB比较差异无统计学意义（P〉0.05）;死亡组治疗第3天、治疗第9天、治疗第18天和末次PALB明显低于生存组[（107.2±17.4）mg/L比（126.3±33.2）mg/L、（91.2±11.9）mg/L比（137.9±35.7）mg/L、（54.7±14.8）mg/L比（151.9±27.9）mg/L和（43.3±19.7）mg/L比（159.3±41.2）mg/L],差异有统计学意义（P〈0.05）.结论 血浆PTA和血清AFP、PALB与人工肝血浆置换治疗重症肝炎的疗效关系密切,且动态观察其变化情况可有助于判断病情.

Objective To investigate the clinical significance of plasma prothrombin activity （PTA） and serum alpha fetoprotein （AFP）, prealbumin （PALB） in severe hepatitis patients treated with artificial liver plasma exchange. Methods The clinical data of 31 patients with severe hepatitis were retrospectively analyzed. The patients were treated with artificial liver plasma exchange based on the comprehensive treatment. The patients were divided into survival group （17 cases） and death group （14 cases） according to the clinical outcome. The plasma prothrombin time （PT） and serum AFP, PALB levels were detected before treatment, 3rd, 9th and 18th day after treatment and at the last time （prior to discharge/ in extrimis）, and the PTA was counted. Results There was no statistical difference in PTA before treatment and 3rd day after treatment between 2 groups （P〉0.05）. The PTA levels 9th and 18th day after treatment and at the last time in death group were significantly lower than those in survival group：（30.17 ± 4.79）％vs. （39.74 ± 4.77）％, （25.47 ± 6.46）％vs. （42.79 ± 6.88）％and （21.40 ± 9.17）％vs. （47.17 ± 5.46）％,and there were statistical differences （P〈0.05）. There was no statistical difference in AFP before treatment between 2 groups （P〉0.05）;the AFP levels 3rd, 9th and 18th day after treatment and at the last time in death group were significantly lower than those in survival group：（121.9 ± 31.7）μg/L vs. （134.6 ± 31.8）μg/L, （88.7 ± 40.8）μg/L vs. （169.9 ± 41.7）μg/L, （56.9 ± 29.7）μg/L vs. （176.8 ± 48.1）μg/L and （29.8 ± 15.7） μg/L vs. （204.3 ± 41.2） μg/L, and there were statistical differences （P〈0.05）. There was no statistical difference in PALB before treatment between 2 groups （P〉0.05）; the PALB levels 3rd, 9th and 18th day after treatment and at the last time in death group were significantly lower than those in survival group： （107.2 ± 17.4） mg/L vs. （126.3 ± 33.2） mg/L, （91.2 ± 11.9） mg/L vs. （137.9 ± 35.7） mg/L, （54.7 ± 14.8） mg/L vs. （151.9 ± 27.9） mg/L and （43.3 ± 19.7） mg/L vs. （159.3 ± 41.2） mg/L, and there were statistical differences （P〈0.05）. Conclusions The plasma PTA and serum AFP, PALB levels are closely related with curative effect of artificial liver plasma exchange in severe hepatitis patients, and dynamic observation of its changes can help to determine the condition.