血浆吸附灌流联合血浆置换加用恩替卡韦治疗乙型肝炎相关慢加急性肝衰竭的临床疗效

摘要

目的 观察血浆吸附灌流(PP)联合血浆置换(PE)的组合型人工肝方法加恩替卡韦抗病毒治疗乙型肝炎相关慢加急性肝衰竭( HBV - ACLF)的临床疗效.方法 将PP和使用少量血浆的PE联合在1次治疗模式中完成,治疗35例68例次肝衰竭患者,检测治疗前、结束时及治疗结束72 h时患者血清总胆红素(TBil)、凝血酶原活动度(PTA)、血清白蛋白(Alb),与同期进行的34例66例次单纯PE治疗患者做对照,两组患者皆予恩替卡韦抗病毒治疗.结果 (1)治疗1个月时并发症发生率2组间差异无统计学意义(P＞0.05).治疗1个月时HBV DNA下降超过100倍的患者比率分别为治疗组68.6％,对照组61.8％,2者差异无统计学意义(P＞0.05).(2)治疗组和对照组患者治疗1个月时好转率(62.9％,61.8％),生存率(68.6％,64.7％),累积3个月生存率(65.7％,64.7％),6个月生存率(65.7％,61.8％),差异皆无统计学意义(P均＞0.05).(3)2组患者治疗结束及治疗结束72 h时TBil均明显低于治疗前水平(P均＜0.05),治疗组在治疗结束时TBil下降幅度更大(P＜0.05),在治疗结束72 h时2组间比较差异无统计学意义(P＞0.05).治疗组患者在治疗结束时PTA无明显升高(P＞0.05),而对照组在治疗结束时PTA升高(P＜0.05).治疗组患者在治疗结束时Alb较治疗前无明显变化(P＞0.05),而对照组在治疗结束时Alb显著升高(P＜0.05).结论 本研究建立的PP联合PE及恩替卡韦抗病毒治疗方法,血浆用量少,抗病毒疗效好,治疗HBV - ACLF患者安全有效.%Objective To evaluate the therapeutic efficacy of combination therapy comprised of plasma perfusion ( PP) , and plasma exchange ( PE) , and entecavir for treating patients with hepatitis B virus ( HBV) - related acute - on - chronic liver failure ( ACLF) . Methods Seventy - six patients with HBV - ACLF were divided into two equal treatment groups: control, receiving the basic treatment of PE (time; 1.5-2.5 h, blood flow rate; 110 - 150 ml/min, plasma separation rate: 20 -30 ml/min, replacement plasma volume; 2200 -2800 ml) and entecavir (0. 5 mg/d) for four weeks; combination therapy, receiving the basic treatment plus PP absorption. Serum levels of total bilirubin ( Tbil) , prothrombin activity ( PTA) , and albumin ( Alb) were measured before treatment, at the end of treatment, and at 72 h post - treatment. Results The total effective rate of the combination therapy group was significantly higher than that of the control group (62. 9% vs. 61. 8% , P > 0. 05). Serum Tbil levels at the end of treatment and at 72 h post - treatment were significantly lower than those before treatment for both groups (P <0. 05) , but the decrease in levels was significantly more extensive in the combination therapy group than in the control group ( P < 0.05). Levels of PTA and Alb in the control groups were significantly higher at the end of treatment than before treatment ( P < 0. 05) , and the levels were even more extensively decreased at 72 h post - treatment ( P < 0. 05 ) . Compared with the pre - therapy levels, serum PTA and Alb in the combination therapy group were not different at the end of treatment or at 72 h post - treatment. Conclusion Adding PP to the basic therapy of PE and entecavir increases the efficacy for treating HBV - ACLF.