富马酸替诺福韦二吡呋酯联合双重血浆分子吸附系统序贯血浆 置换治疗慢加急性乙型肝炎肝衰竭患者疗效分析

Efficacy of tenofovir disoproxil fumarate and double plasma molecular absorb system plus plasma exchange in treatment of patients with HBV-induced acute-on-chronic liver failure

目的分析富马酸替诺福韦二吡呋酯片(TDF)联合双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者的临床效果。方法2016年9月~2019年9月收治的HBV-ACLF患者50例,其中25例观察组采用TDF联合DPMAS序贯PE治疗,另25例对照组采用TDF联合PE治疗。采用ELISA法检测血清白细胞介素-6(IL-6)。结果在治疗12周末,观察组血清胆红素水平为(24.0±14.5)μmol/L,国际标准化比值为(1.1±0.3),显著低于对照组【分别为(31.6±15.9)μmol/L和(1.3±0.4),P<0.05】,而血清白蛋白水平为(34.8±6.1)g/L,显著高于对照组【(30.9±5.2)g/L,P<0.05】;血清IL-6水平为(52.7±25.2)ng/L,降钙素原为(0.4±0.1)ng/L,血小板/淋巴细胞比值为(120.6±24.4),和中性粒细胞/淋巴细胞比值为(1.9±0.5),显著低于对照组【分别为(67.2±30.8)ng/L、(0.5±0.2)ng/L、(139.3±26.7)和(2.4±0.6),P<0.05】;对照组生存12例(48.0%),观察组生存18例(72.0%,P<0.05)。结论TDF联合DPMAS序贯PE治疗HBV-ACLF患者近期疗效较好,可能与有效清除了血清内毒素,降低了细胞因子水平,改善了肝功能有关。

Objective The aim of this study was to evaluate the efficacy of tenofovir disoproxil fumarate(TDF)and double plasma molecular absorb system(DPMAS)plus plasma exchange(PE)in treatment of patients with HBV-induced acuteon-chronic liver failure(HBV-ACLF).Methods 50 patients with HBV-ACLF HBV-ACLF were enrolled in this study and were divided into observation(n=25)and control group(n=25),receiving TDF,DPMAS and PE combination or TDF and DPMAS treatment.Serum interleukin-6 level was assayed by ELISA.Results At the end of 12 week treatment,serum bilirubin level in the observation group was(24.0μmol/L,INR was(1.1±0.3),both significantly lower than【(31.6±15.9)μmol/L and(1.3±0.4),respectively,P<0.05】,while serum albumin level was(34.8±6.1)g/L,significantly higher than【(30.9±5.2)g/L,P<0.05】in the control;serum IL-6 level was(52.7±25.2)ng/L,procalcitonin level was(0.4±0.1)ng/L,platelet-to-lymphocyte ratio was(120.6±24.4),and neutrophil-to-lymphocyte ratio was(1.9±0.5),all significantly lower than【(67.2±30.8)ng/L,(0.5±0.2)ng/L,(139.3±26.7)and(2.4±0.6),respectively,P<0.05】in the control;the survival rate was significantly higher than that in the control group(72.0%vs.48.0%,P<0.05).Conclusion TDF combined with DPMAS and PE in treatment of patients with HBV-ACLF is efficacious,which might be related to the reduction of blood endotoxin and improve liver function recovery.