血浆置换联合连续性血液滤过治疗肝衰竭前期临床分析

Clincal analysis of therapeutic plasma exchange plus continuous hemodiafiltration in the treatment of patients with pre-liver failure

目的:观察血浆置换(plasma exchange,PE)联合连续性血液滤过(continuous hemodiafiltration,CHDF)治疗肝衰竭前期(pre-liver failure,pre-LF)患者的临床疗效。方法:对49例肝衰竭前期患者临床资料回顾性分析,对照组为20例单纯内科综合治疗患者,治疗组为29例在内科综合治疗基础上进行PE联合CHDF治疗的患者。比较2组患者治疗1周后的血生化指标、临床转归等情况。结果:治疗组进行非生物型人工肝治疗(non-biologic artificial liver support system,NBALSS)后患者乏力、纳差、黄疸等症状得到改善,血C-反应蛋白(C reactive protein,CRP)[(19.04±11.37)mg/L vs.(54.81±37.60)mg/L]、白介素-6(interleukin 6,IL-6)[(17.01±9.86)pg/m L vs.(31.86±13.01)pg/m L]、谷氨酸转氨酶(alanine aminotransferase,ALT)[(88.59±51.06)U/L vs.(279.93±69.75)U/L]、总胆红素(total bilirubin,TBIL)[(67.39±35.22)μmol/L vs.(133.21±26.52)μmol/L]均明显下降(t值分别为6.28、7.51、12.26、7.40,均P=0.00),血凝血酶原活动度(serum prothrombin activity,PTA)水平明显升高[(88.86±20.16)%vs.(45.70±3.47)%,t=8.81,P=0.00];与对照组比较,差异均有统计学意义[C-反应蛋白:(19.04±11.37)vs.(29.21±22.05),t=2.04,P=0.02;白介素-6:(17.01±9.86)vs.(31.37±11.02),t=4.26,P=0.00;谷氨酸转氨酶:(88.59±51.06)vs.(194.70±90.86),t=4.93,P=0.00;总胆红素:(67.39±35.22)vs.(103.63±69.65),t=2.12,P=0.02;血凝血酶原活动度:(88.86±20.16)%vs.(66.20±14.33)%,t=3.48,P=0.00]。此外,治疗组患者1周后好转率为86.21%,高于对照组的55.0%(χ2=5.94,P=0.015)。29例治疗组患者中死亡1例,20例对照组患者中死亡2例。结论:血浆置换联合连续性血液滤过治疗肝衰竭前期疗效优于对照组,提高了患者近期的好转率。

Objective：To investigate the clinical effect of plasma exchange （PE） plus continuous hemodiafihration （CHDF） on pre- liver failure. Methods： Retrospective analysis was made on the clinical data in the 49 patients with pre-liver failure. Twenty-nine patients were treated by PE combined with CHDF based on medical supporting treatment and 20 patients were treated by medical supporting treatment alone. Their therapenutic effects on biochemical parameters and clinical outcome were observed and compared between the two groups. Results：Symptoms such as fatigue, poor appetite, and jaundice were relieved after non-biologic artificial liver support system（NBALSS）. The levels of C reactive protein（CRP）,interleukin （IL）-6, alanine aminotransferase （ALT）,total bilirubin （TBIL） after treatment decreased, and serum prothrombin activity（PTA） level increased in the PE plus CHDF group. While,all of the biochemical indictors after treatment differed significantly between the two group（all P〈0.05）. Patients in the treatment group had a significantly higher improvement rate （X2=-5.935, P=0.015） compared with that in the control group. Concluslon：The curative effect of PE plus CHDF based on medical supporting treatment is more remarkable than that of medical supporting treatment alone;thei＇apeutic PE plus CHDF significantly increases the improvement rate of patients with pre-liver failure.