人工肝PE+CHDF与PDF治疗晚期肝衰竭疗效对比临床研究

Clinical study on the efficacy of artificial liver PE +CHDF and PDF in the treatment of advanced liver failure

目的探讨人工肝血浆置换(Plasma exchange,PE)+血液滤过透析(hemodiafiltration, CHDF)模式与人工肝血浆滤过透析(Artificial extracorporeal liver,PDF)模式在晚期肝衰竭患者临床疗效、不良反应以及成本效益。方法选取不同肝衰竭晚期患者60例,随机均分为PE+CHDF组和PDF组;PE+CHDF组在常规治疗基础上加用PE+CHDF治疗,PDF组在常规治疗上加用PDF治疗,观察比较两组在治疗前后临床症状、实验室检查结果、不良反应发生情况、凝血酶原活动度(Prothrombin activity,PTA)以及患者死亡率。结果 PE+CHDF组治疗后症状表现较前好转,有效率达84%,而PDF组治疗后有效率达71%,两者差异具有统计学意义(P<0.05);治疗后PE+CHDF组与PDF组T-BIL、BUN、AST、ALT、血氨、Cr均有统计学差异(P<0.05);PE+CHDF组过敏反应与置管处渗血发生率均低于PDF组,有统计学差异(P<0.05);PE+CHDF组治疗后PTA值明显高于PDF组,有统计学差异(P<0.05);PE+CHDF组较PDF组存活率无统计学差异(P>0.05)。结论与PDF相比,晚期肝衰竭患者在内科综合治疗基础上配合PE+CHDF治疗能够提高临床疗效,有效改善患者肝功能与凝血功能,降低过敏反应与置管处渗血发生率,但两组患者死亡率无明显差异,临床要根据患者实际情况灵活选择人工肝方式治疗。

Objective To investigate the clinical efficacy, adverse reactions and cost-benefit of artificial liver plasma exchange (Plasma exchange,PE) hemofiltration dialysis (hemodiafiltration, CHDF) model and artificial liver plasma filtration dialysis (Artificial extracorporeal liver, PDF) model in patients with advanced liver failure. Methods 60 patients with advanced liver failure were randomly divided into PE CHDF group and PDF group;PE CHDF group. PE CHDF was used on the basis of treatment, and PDF was added to PDF group before and after treatment. The clinical symptoms, laboratory results, adverse reactions, prothrombin activity (Prothrombin activity,PTA) and mortality were observed and compared between the two groups before and after treatment. Results After treatment, the symptoms of PE CHDF group were improved, the effective rate was 84%, while that of PDF group was 71%, there was significant difference between the two groups (P<0.05), and there was significant difference between the two groups after treatment (P<0.05), and there was significant difference between the two groups after treatment (P<0.05). The blood ammonia and Cr of ALT, group were better than those of PDF group, and there was significant difference between the two groups (P<0.05). The incidence of allergic reaction and catheterization in);PE CHDF group was significantly lower than that in PDF group (P<0.05). The PTA value in);PE CHDF group was significantly higher than that in PDF group after treatment, and there was no significant difference in mortality between);PE CHDF group and PDF group (P>0.05). Conclusion Compared with PDF, combined with PE CHDF can improve the clinical efficacy of patients with advanced liver failure on the basis of comprehensive medical treatment. It is worth popularizing to effectively improve the liver function and coagulation function of the patients and reduce the incidence of allergic reactions and bleeding at the catheterization.