血浆置换术治疗不同严重度乙肝相关性肝衰竭的对比研究

A Comparative Study of Plasma Exchange in the Treatment of Hepatitis B Related Liver Failure With Different Severity

目的探析血浆置换术治疗不同严重度乙肝相关性肝衰竭(HBV-liver failure,HBV-LF)的临床效果。方法将2015年3月到2020年3月本院接治的125例HBV-LF患者纳入研究中,根据integrated终末期肝病模型(integrated model for End-Stage Liver Disease,iMELD)评分分为Ⅰ组(iMELD<35分),Ⅱ组(35分≤iMELD<45分)、Ⅲ组(45分≤iMELD<55分)、Ⅳ组(iMELD≥55分)四组。均采取血浆置换术治疗,对比分析有效率及治疗前后生化指标变化。结果I组有效率为93.55%,Ⅱ组为80.00%,Ⅲ组为61.76%,Ⅳ组为33.33%,组间差异有统计学意义(P<0.05)。治疗后Ⅰ组TBil、ALB、ALT、AST、PTA、INR均有显著变化,II组除ALB、Na+外,其余指标均有显著变化,Ⅲ组患者TBil、AST、ALT、PTA有显著变化,Ⅳ组ALT显著变化,均与同组治疗前差异有统计学意义(P<0.05)。结论血浆置换术治疗HBV-LF有确切效果,但病情越轻患者临床效果越佳。

Objective To explore the clinical effect of plasma exchange in the treatment of hepatitis B-related liver failure(HBV-LF).Methods 125 patients with HBV-LF admitted to our hospital from March 2015 to March 2020 were included in the study.According to the iMELD score,they were divided into four groups:groupⅠ(iMELD<35),group II(35≤iMELD<45),groupⅢ(45≤iMELD<55),and groupⅣ(iMELD≥55).All patients were treated with plasma exchange.The effective rate and biochemical indexes before and after treatment were compared and analyzed.Results The effective rate was 93.55%in group I,80.00%in groupⅡ,61.76%in groupⅢand 33.33%in groupⅣ.The difference was statistically significant(P<0.05).After treatment,TBiL,ALB,ALT,AST,PTA,INR in groupⅠwere significantly changed,except ALB and Na+in groupⅡ,TBIL,AST,ALT and PTA in groupⅢwere significantly changed,and ALT in groupⅣwas significantly changed,with statistically significant differences compared with those before treatment in the same group(P<0.05).Conclusion Plasma exchange is effective in the treatment of HBV-LF,but the lighter the patient’s condition is,the better the clinical effect is.