双重血浆置换对跨血型肝脏移植术患者肝肾影响及远期效果影响

Effect of double plasma exchange on liver and kidney of patients undergoing trans-blood liver transplantation and its long-term effect

目的探究双重血浆置换对跨血型肝脏移植术患者肝肾功能的影响,并对治疗远期效果进行随访;方法选取2016-01至2019-05于我院接受肝脏移植术的49例ABO血型不合患者为研究对象,按照其个人选择治疗方式的不同将其分为实验组(n=30)和对照组(n=19),试验组采用双重血浆置换术,对照组采用血浆置换术,两组接受同样的内科治疗,对比两组患者接受治疗前后抗体滴度及肝肾功能指标如谷丙转氨酶(Alanine aminotransferase,ALT)、谷草转氨酶(Aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBil)、血清白蛋白水平的变化,对比两组患者接受肝移植后各类并发症的发生率,对两组患者均实施为期12个月的随访,记录对比急性排斥反应及病死率。结果(1)对比显示,实验组患者治疗后抗体滴度低于对照组(P<0.05)。(2)实验组患者治疗后ALT、AST、TBil水平明显低于对照组,血清白蛋白明显高于对照组(P<0.05);(3)治疗中不良反应发生率实验组低于对照组(P<0.05);(4)随访显示,实验组患者急性排斥反应及病死率低于对照组(P<0.05);结论跨血型肝脏移植患者接受双重血浆置换治疗后肝肾功能指标会得到显著改善,同时双重血浆置换治疗还能够降低患者排斥反应发生率,提高移植成功率。

Objective To explore the effect of dual plasma exchange on liver and kidney function of patients undergoing transblood liver transplantation,and to follow up the long-term results of treatment.Methods 49 patients who received liver transplantation with ABO blood incompatibility in our hospital from January 2016 to May 2019 were the research subjects.They were divided into experimental group(n=30)and control group(n=19)according to their personal choice of treatment.The experimental group used double plasma exchange and the control group used plasma exchange.The two groups received the same medical treatment.The changes in antibody titers and liver and kidney function indexes such as alanine aminotransferase(ALT),Aspartate aminotransferase(AST)and total bilirubin were compared before and after treatment.The serum albumin levels,and compared the incidence of various complications after liver transplantation between the two groups were compared.A 12-month follow-up was carried out for both groups of patients.Acute rejection and mortality were recorded and compared.Results(1)The comparison showed that the antibody titers of the experimental group after treatment were than those of the control group,and the differences were statistically significant(P<0.05);(2)The levels of ALT,AST and TBil in the experimental group were significantly lower than those of the control group after treatment,and the serum albumin was significantly higher than the control group,and the differences were statistically significant(P<0.05);(3)The incidence of adverse reactions in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05);(4)Follow-up showed that the acute rejection and mortality of the experimental group were lower than the control group,and the difference was statistically significant(P<0.05).Conclusions The liver and kidney function indexes of patients with trans-blood liver transplantation receiving dual plasma exchange treatment will be significantly improved,and dual plasma exchange treatment can also reduce the incidence of rejection in patients and increase the success rate of transplantation.