人工肝血浆置换联合CRRT治疗乙肝相关慢加急性肝衰竭合并急性肾衰竭效果及对预后的影响

Effect of Artificial Liver Plasma Exchange Combined with CRRT in the Treatment of Hepatitis B-Related Chronic Acute Liver Failure Complicated with Acute Renal Failure and Its Impact on Prognosis

目的探究人工肝血浆置换联合连续肾脏替代疗法(CRRT)治疗乙肝相关慢加急性肝衰竭(ACLF)合并急性肾衰竭(ARF)患者的效果及对预后的影响。方法回顾性分析2019年5月—2020年10月收治的乙肝相关ACLF合并ARF 62例的临床资料,按治疗方法分为观察组和对照组,每组31例。观察组实施人工肝血浆置换联合CRRT治疗方案,对照组实施人工肝血浆置换治疗方案。比较2组治疗前及治疗4周后肝肾功能、炎性因子、血常规指标、电解质水平;比较2组治疗后90 d内生存情况。结果治疗4周后,2组丙氨酸转氨酶、总胆红素、尿素、肿瘤坏死因子-α、干扰素-γ、白细胞介素-12均较治疗前降低,且观察组低于对照组(P<0.05)。治疗4周后,2组血红蛋白、血小板计数水平较治疗前降低(P<0.05)。治疗4周后,2组凝血酶原活动度、肾小球滤过率、内生肌酐清除率均显著升高,且观察组高于对照组(P<0.05)。治疗4周后,2组治疗前后血钾、血钠、血氯水平比较差异无统计学意义(P>0.05)。观察组生存时间长于对照组(P<0.05)。结论人工肝血浆置换联合CRRT治疗乙肝相关ACLF合并ARF效果较好,有助于促进肝肾功能改善,对机体电解质水平影响较小,可有效抑制炎症反应,延长患者生存时间。

Objective To explore the effect of artificial liver plasma exchange combined with continuous renal replacement therapy(CRRT)in the treatment of patients with hepatitis B-related acute-on-chronic liver failure(ACLF)complicated with acute renal failure(ARF)and its impact on the prognosis and outcomes.Methods Clinical data of 62 patients with HBV-related ACLF complicated with ARF treated from May 2019 to October 2020 were retrospectively analyzed,and were divided into observation group(n=31)and control group(n=31)according to treatment methods.The observation group received artificial liver plasma exchange combined with CRRT,and the control group received artificial liver plasma exchange.Liver and kidney function,inflammatory factors,blood routine indexes and electrolyte levels were compared before and at 4 weeks after treatment.The 90-day survival of the two groups after treatment was compared.Results At 4 weeks after treatment,alanine aminotransferase,total bilirubin,urea,tumor necrosis factor-α,interferon-γ and interleukin-12 in the two groups were lower than those before treatment,and lower in the observation group than in the control group(P<0.05).At 4 weeks after treatment,hemoglobin and platelet count levels in the two groups were decreased compared with those before treatment(P<0.05).At 4 weeks after treatment,prothrombin activity,glomerular filtration rate and endogenous creatinine clearance in the two groups were significantly higher,which were higher in the observation group than in the control group(P<0.05).At 4 weeks after treatment,there was no significant difference in blood potassium,blood sodium and blood chlorine levels between the two groups before and after treatment(P>0.05).The survival time of observation group was longer than that of control group(P<0.05).Conclusion Artificial liver plasma exchange combined with CRRT is effective in the treatment of hepatitis B-related ACLF combined with ARF,which helps to improve liver and kidney function,has little impact on the body's electrolyte level,and can effectively inhibit inflammation and prolong the survival of patients.