血浆置换联合替诺福韦酯治疗HBV感染相关慢加急性肝衰竭的疗效

Effect of plasma exchange combined with Tenofovir dipivoxil on treatment of HBV infection-related acute-on-chronic-liver failure

目的探讨血浆置换(PE)联合替诺福韦酯(TDF)治疗乙型肝炎病毒(HBV)感染相关慢加急性肝衰竭(ACLF)患者的临床效果。方法选取2017年1月-2019年12月商丘市立医院收治的HBV感染所致ACLF患者160例作为研究对象,根据患者治疗方式分为TDF组(常规内科治疗+TDF治疗,78例)和PE联合TDF组(常规内科治疗+TDF治疗+PE,82例),比较两组ACLF患者血生化、HBV病毒载量以及肝功能指标差异。结果TDF组、PE联合TDF组治疗前的血红蛋白(HGB)、白蛋白(Alb)、总胆固醇、三酰甘油、白细胞计数(WBC)、血小板(PLT)、凝血酶原活动度(PTA)、血清肌酐(Scr)、HBV DNA载量、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、间接胆红素(IBIL)、直接胆红素(DBil)、碱性磷酸酶(ALP)水平比较,差异均无统计学意义;与治疗前相比,TDF组、PE联合TDF组治疗后的Alb、PTA水平均升高,Scr、HBV DNA载量、ALT、AST、TBIL、IBIL、DBil、ALP水平均降低(P<0.05)。PE联合TDF组治疗后的Alb、PTA水平均高于TDF组,而Scr、HBV DNA载量、ALT、AST、TBIL、IBIL、DBil、ALP水平均低于TDF组(P<0.05)。TDF组、PE联合TDF组患者皮疹、发热、恶心、血压降低、心悸等不良反应发生率比较,差异无统计学意义。结论PE联合TDF治疗可以降低HBV载量,改善机体肝功能状态,安全性好。

OBJECTIVE To explore the clinical effect of plasma exchange(PE)combined with tenofovir disoproxil fumarate(TDF)on treatment of hepatitis B virus(HBV)infection-induced acute-on-chronic-liver failure(ACLF).METHODS A total of 160patients with HBV infection-induced ACLF who were treated in the Shangqiu Municipal Hospital from Jan 2017to Dec 2019were recruited as the study subjects and divided into the TDF group with 78 cases(the conventional internal medicine treatment plus TDF)and the PE combined with TDF group with 82cases(conventional internal medicine treatment plus TDF plus PE).The biochemical indexes,HBV load and liver function indexes were observed and compared between the two groups of ACLF patients.RESULTS There were no significant differences in hemoglobin(HGB),albumin(Alb),total cholesterol,triglyceride,white blood cell count(WBC),platelet(PLT),prothrombin activity(PTA),CRE,HBV-DNA load,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),indirect bilirubin(IBIL),direct bilirubin(DBil)and alkaline phosphatase(ALP)between the TDF group and the PE combined with TDF group before the treatment.The levels of Alb and PTA of the TDF group and the PE combined with TDF group were significantly higher after the treatment than before the treatment,while the levels of CRE,HBV-DNA load,ALT,AST,TBIL,IBIL,DBil and ALP were significantly lower after the treatment than before the treatment(P<0.05).The levels of Alb and PTA of the PE combined with TDF group were significantly higher than those of the TDF group after the treatment,while the levels of CRE,HBV-DNA load,ALT,AST,TBIL,IBIL,DBiL and ALP of the PE combined with TDF group were significantly lower than those of the TDF group(P<0.05).There was no significant difference in the incidence of adverse reactions rash,fever,nausea,blood pressure reduction and palpitation between the TDF group and the PE combined with TDF group.CONCLUSIONPE combined with TDF may reduce the HBV load and improve the liver function status of the body,with the safety high.