连续性肾脏替代疗法治疗肝性脑病型重型肝炎的临床研究

Clinical study of treatment with continuous renal replacement therapy on severe hepatitis with hepatic encephalopathy

目的 :探讨连续性肾脏替代疗法 (CRRT)治疗肝性脑病型重型肝炎临床疗效 ,并研究其机制。方法 :4 7例肝性脑病型重型肝炎患者随机分成 3组 :CRRT治疗组、血浆置换 (PE) +CRRT治疗组和基础疗法组 ,前两组在基础疗法组基础上分别予 CRRT或 PE+CRRT治疗。治疗前后检测肝、肾功能 ,血氨 ,肿瘤坏死因子 α(TNFα) ,白介素 6 (IL 6 )等。结果 :CRRT治疗组、PE+CRRT治疗组和基础疗法组患者的清醒率分别为 75 .0 %、86 .7%和 31.3% ,存活率分别为 2 5 .0 %、4 6 .7%和 6 .2 5 % (P均 <0 .0 5 )。CRRT治疗后血清尿素氮、肌酐、血氨、TNFα、IL 6比基础疗法组明显下降 (P均 <0 .0 5 ) ;血清胆红素、总胆汁酸 (TBA)下降和基础疗法组比较无显著变化 (P均 >0 .0 5 )。 CRRT治疗过程中血流动力学稳定 ,并发症少。 CRRT治疗组、PE+CRRT治疗组肝性脑病 ～ 期患者的存活率分别为 4 4 .4 %和 6 2 .5 % ,明显高于 ～ 期患者的存活率 0和2 8.6 % (P<0 .0 5 )。结论 :CRRT是辅助治疗肝性脑病型重型肝炎的有效方法 ;早期联合

Objective:To evaluate clinical significance and the therapeutic mechanisms of the treatment with continuous renal replacement therapy on severe hepatitis with hepatic encephalopathy.Methods:Fortyseven cases were randomly divided into three groups:continuous renal replacement therapy(CRRT) group,plasma exchange(PE)+CRRT group and basic treatment group.The former two groups were respectively operated by CRRT and PE+ CRRT with basic treatment.Serum biochemical tests,amino,tumor necrosis factorα (TNFα) and interleukin6(IL6) were performed before and after treatment with CRRT.Results:75 0% patients in CRRT group and 86 7% patients in PE+CRRT group regained normal consciousness,but in basic treatment group 31 3%,achieved a normal neurologic recovery (all P <0 05).The survival rate of patients in CRRT group,PE+CRRT group and basic treatment group were respectively 25 0%,46 7%, 6 25% ( all P <0 05). It was showed that renal function and serum amino were markedly improved after treatment with CRRT ,serum TNFα and IL6 decreased (all P <0 05).There were no changes in levels of serum bilirubin and total bile acid.The hemodynamic function was kept stable and there were no complications during the CRRT therapy. The survival rate of patients was associated with the degree of hepatic encephalopathy in CRRT group,PE+CRRT group ( P <0 05).Conclusions:Our results show that CRRT is an effective mean in treating severe hepatitis with hepatic encephalopathy and obviously increase the survival rate combined with PE in early hepatic encephalopathy.