肝衰竭患者血浆置换治疗后血清胆红素和凝血酶原活动度变化规律浅探

Preliminary study on therapeutic efficacy of plasma exchange in the treatment of patients with liver failure

目的研究血浆置换(PE)治疗肝衰竭患者血清胆红素和凝血酶原活动度变化规律。方法2015年2月~2018年8月安徽医科大学第二附属医院肝病科住院的肝衰竭患者47例,分别接受3次以上PE治疗。采用二元多因素Logistic回归分析影响肝衰竭患者短期预后的因素。结果在治疗12 w末,本组47例患者生存22例(46.8%),死亡25例;25例死亡患者年龄为(47.5±13.4)岁、基线MELD评分为(33.5±6.1)分、PTA为(23.8±10.1)%、APTT为(93.8±40.6)s,与22例生存患者比,差异显著[分别为(37.0±6.2)岁、(27.9±4.0)分、(33.9±9.3)%和(64.7±27.2)s,P<0.05],死亡组肝性脑病发生率为64.0%,显著高于生存组的27.3%(P<0.05);多因素Logistic回归分析提示年龄和基线PTA是影响肝衰竭患者短期预后的独立危险因素;经线性回归分析发现,PE术后TBIL下降与术前TBIL水平呈正相关(r=0.866,P<0.05),首次PE术后PTA升高最显著(P<0.05)。结论年龄和凝血酶原活动度是影响肝衰竭患者预后的独立危险因素,了解这些重要的指标对判断病情和及时地给予处理对改善预后很有帮助。

Objective The aim of this study was to investigate the therapeutic efficacy of plasma exchange(PE)in the treatment of patients with liver failure.Methods A total of 47 patients with liver failure were admitted to the Second Affiliated Hospital,Anhui Medical University from February 2015 through August 2018,and all patients underwent three or more PE treatment,and followed-up for 12 weeks.Multivariate Logistic analysis was applied to reveal the impacting factors of survival.Results At the end of 12 weeks,22(46.8%)survived,and 25 died;the age,baseline MELD score,PTA and APTT in the fatal group were(47.5±13.4)yr,(33.5±6.1),(23.8±10.1)%and(93.8±40.6)s,significantly different compared to[(37.0±6.2)yr,(27.9±4.0),(33.9±9.3)%and(64.7±27.2)s,respectively,P<0.05],and the incidence of hepatic encephalopathy in fatal group was 64.0%,significantly higher than 27.3%(P<0.05)in survivals;multivariate Logistic analysis showed that the age and baseline PTA were the independent factors affecting prognosis of patients with liver failure;the decreased serum bilirubin levels after PE were positively correlated to serum bilirubin levels before(r=0.866,P<0.05),and the PTA increased most obviously after first PE treatment(P<0.05).Conclusion Our findings suggest that patients’age and baseline PTA are the independent risk factors for short-term prognosis in patients with liver failure,and the clinicians should take these factors into consideration in clinical practice to deal with in time.