BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degre...BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.展开更多
目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者...目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者的凝血酶原时间(PT)、凝血酶时间(TT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(T-BILI)、直接胆红素(D-BILI)和总胆汁酸(TBA)等生化指标的变化;同时观察2组患者的临床症状及体征的改变,评价整体疗效,并在统计分析患者病情分期、并发症与血浆置换治疗重型肝炎疗效的关系后,做出临床评判。结果 1)PE组治疗前后凝血功能和肝功能生化指标分别为:PT(s)24.5±9.19 vs17.8±6.71、TT(s)16.6±3.87 vs 17.9±11.82、ALT(U/L)281.2±271.16 vs 69.4±91.97、AST(U/L)285.8±247.91vs 64.8±43.94、T-BILI(μmol/L)407.0±178.99 vs 238.2±143.76、D-BILI(μmol/L)316.1±131.09 vs 167.4±110.85、TBA(μmol/L)141.7±83.56 vs 140.6±86.26;2)总体有效率(%),PE与对照组为56.41 vs 30.00,其中早、中、晚期的重型肝炎有效率分别为81.25 vs 41.67、53.85 vs 40.00、20.00 vs 12.50(P<0.05);3)并发自发性腹膜炎的患者治疗后的有效率(%),PE与对照组分别为70.00 vs 40.00。结论 PE是治疗重型肝炎的1种安全、有效方法;对于早期重症肝炎患者疗效优于中晚期重症肝炎患者,对合并自发性腹膜炎患者的疗效优于单纯内科综合疗法。展开更多
目的:探讨干扰素诱导蛋白10(IP-10)与重型乙型肝炎(SHB)患者肝脏炎症程度及病情发展的关系.方法:采集SHB患者40例血浆置换(PE)开始、结束及PE后5d血清,根据SHB患者PE后5d病情转归情况分为好转组及恶化组;采集慢性乙型肝炎(CHB)患者及健...目的:探讨干扰素诱导蛋白10(IP-10)与重型乙型肝炎(SHB)患者肝脏炎症程度及病情发展的关系.方法:采集SHB患者40例血浆置换(PE)开始、结束及PE后5d血清,根据SHB患者PE后5d病情转归情况分为好转组及恶化组;采集慢性乙型肝炎(CHB)患者及健康对照各20例血清;双抗体夹心ELISA法检测血清干扰素(IFN)诱导蛋白10(IP-10)、肿瘤坏死因子-α(TNF-α)水平.常规检测SHB患者入院时、PE后5d总胆红素(TB),凝血酶原活动度(PTA).结果:入院时SHB及CHB组血清IP-10均高于健康对照组(683.56±174.63,216.13±102.92 vs 107.61±55.81,P<0.01),SHB组高于CHB组(P<0.01);SHB患者血清IP-10与TNF-α呈正相关(r=0.366;P<0.05),与PTA呈负相关(r= -0.401;P<0.05),与TB相关性不明显(r=0.223,P>0.05).PE后5d SHB好转组及恶化组较入院时血清IP-10均明显下降(P<0.01,P<0.05),恶化组高于好转组(P<0.01).结论:血清IP-10参与了SHB肝脏的免疫损伤;IP-10水平与肝脏炎症损害程度有关;动态观察IP-10在SHB患者PE前后的变化,能反映SHB患者病情发展及转归.展开更多
文摘BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.
文摘目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者的凝血酶原时间(PT)、凝血酶时间(TT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(T-BILI)、直接胆红素(D-BILI)和总胆汁酸(TBA)等生化指标的变化;同时观察2组患者的临床症状及体征的改变,评价整体疗效,并在统计分析患者病情分期、并发症与血浆置换治疗重型肝炎疗效的关系后,做出临床评判。结果 1)PE组治疗前后凝血功能和肝功能生化指标分别为:PT(s)24.5±9.19 vs17.8±6.71、TT(s)16.6±3.87 vs 17.9±11.82、ALT(U/L)281.2±271.16 vs 69.4±91.97、AST(U/L)285.8±247.91vs 64.8±43.94、T-BILI(μmol/L)407.0±178.99 vs 238.2±143.76、D-BILI(μmol/L)316.1±131.09 vs 167.4±110.85、TBA(μmol/L)141.7±83.56 vs 140.6±86.26;2)总体有效率(%),PE与对照组为56.41 vs 30.00,其中早、中、晚期的重型肝炎有效率分别为81.25 vs 41.67、53.85 vs 40.00、20.00 vs 12.50(P<0.05);3)并发自发性腹膜炎的患者治疗后的有效率(%),PE与对照组分别为70.00 vs 40.00。结论 PE是治疗重型肝炎的1种安全、有效方法;对于早期重症肝炎患者疗效优于中晚期重症肝炎患者,对合并自发性腹膜炎患者的疗效优于单纯内科综合疗法。
文摘目的:探讨干扰素诱导蛋白10(IP-10)与重型乙型肝炎(SHB)患者肝脏炎症程度及病情发展的关系.方法:采集SHB患者40例血浆置换(PE)开始、结束及PE后5d血清,根据SHB患者PE后5d病情转归情况分为好转组及恶化组;采集慢性乙型肝炎(CHB)患者及健康对照各20例血清;双抗体夹心ELISA法检测血清干扰素(IFN)诱导蛋白10(IP-10)、肿瘤坏死因子-α(TNF-α)水平.常规检测SHB患者入院时、PE后5d总胆红素(TB),凝血酶原活动度(PTA).结果:入院时SHB及CHB组血清IP-10均高于健康对照组(683.56±174.63,216.13±102.92 vs 107.61±55.81,P<0.01),SHB组高于CHB组(P<0.01);SHB患者血清IP-10与TNF-α呈正相关(r=0.366;P<0.05),与PTA呈负相关(r= -0.401;P<0.05),与TB相关性不明显(r=0.223,P>0.05).PE后5d SHB好转组及恶化组较入院时血清IP-10均明显下降(P<0.01,P<0.05),恶化组高于好转组(P<0.01).结论:血清IP-10参与了SHB肝脏的免疫损伤;IP-10水平与肝脏炎症损害程度有关;动态观察IP-10在SHB患者PE前后的变化,能反映SHB患者病情发展及转归.
