血浆置换联合血浆胆红素吸附治疗乙型病毒性肝炎肝衰竭的疗效及安全性

摘要

目的 探讨血浆置换(PE)联合血浆胆红素吸附(PBA)治疗乙型病毒性肝炎肝衰竭的临床效果及安全性.方法 选择2014年5月至2016年5月广西壮族自治区人民医院收治的乙型病毒性肝炎肝衰竭患者75例为研究对象,根据患者治疗意愿分为PE组、PBA组和PE联合PBA(PE+PBA)组,每组25例.对3组患者治疗前后血清丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、白蛋白(ALB)、凝血酶原时间(PT)、凝血酶原活性(PTA)、肌酐(SCr)及血氨水平进行比较,并观察患者的不良反应.结果 治疗前3组患者血清ALT、TBIL、ALB及SCr水平比较差异均无统计学意义(P>0.05).3组患者治疗后血清ALT、TBIL及SCr水平显著低于治疗前(P<0.05).PE组和PE+PBA组患者治疗后血清ALB水平显著高于治疗前(P<0.05),PBA组患者治疗后血清ALB水平显著低于治疗前(P<0.05).3组患者治疗后血清ALT、TBIL及SCr水平比较差异均无统计学意义(P>0.05).PE组和PE+PBA组患者治疗后血清ALB水平显著高于PBA组(P<0.05),PE组与PE+PBA组患者治疗后血清ALB水平比较差异无统计学意义(P>0.05).3组患者治疗前PT、PTA及血氨水平比较差异均无统计学意义(P>0.05).与治疗前比较,3组患者治疗后PT显著缩短,PTA显著升高,血氨水平显著降低(P<0.05).治疗后,与PBA组比较,PE组、PE+PBA组患者PT显著缩短,PTA显著升高,血氨水平显著降低(P<0.05);PE组与PE+PBA组患者PT、PTA及血氨水平比较差异均无统计学意义(P>0.05).PE组和PE+PBA组患者血浆用量分别为(2908.11±287.91)、(1107.24±213.67)mL,PE+PBA组患者血浆用量显著少于PE组(t=23.782,P<0.05).PE组、PBA组和PE+PBA组患者治疗时间分别为(2.90±0.87)、(3.02±0.77)、(3.22±0.69)h,3组患者治疗时间比较差异均无统计学意义(F=1.881,P>0.05).PE组、PBA组和PE+PBA组患者治疗总有效率分别为64.0％(16/25)、56.0％(14/25)、64.0％(16/25),3组患者治疗总有效率比较差异无统计学意义(χ2=7.281,P>0.05).PE组患者皮疹、畏寒寒战、麻木抽搐、静脉穿刺部位感染及渗血发生率分别为32.0％(8/25)、28.0％(7/25)、16.0％(4/25)、8.0％(2/25)、8.0％(2/25),PBA组患者皮疹、畏寒寒战、麻木抽搐、静脉穿刺部位感染及渗血发生率分别为16.0％(4/25)、16.0％(4/25)、12.0％(3/25)、4.0％(1/25)、4.0％(1/25),PE+PBA组患者皮疹、畏寒寒战、麻木抽搐、静脉穿刺部位感染及渗血发生率分别为20.0％(5/25)、20.0％(5/25)、12.0％(3/25)、4.0％(1/25)、4.0％(1/25);PBA组和PE+PBA组患者皮疹、畏寒寒战、麻木抽搐、静脉穿刺部位感染及渗血发生率显著低于PE组(P<0.05);PBA组与PE+PBA组患者皮疹、畏寒寒战、麻木抽搐、静脉穿刺部位感染及渗血发生率比较差异均无统计学意义(P>0.05).结论 PE联合PBA治疗乙型病毒性肝炎肝衰竭疗效肯定,安全可行,且可以减少血浆用量.%Objective To investigate the clinical effect of plasma exchange(PE)combined with plasma bilirubin ad-sorption(PBA)in the treatment of liver failure associated with hepatitis B virus(HBV). Methods A total of 75 patients with HBV related liver failure were selected from May 2014 to May 2016 in the People's Hospital of Guangxi Zhuang Autonomous Region. The patients were divided into PE group,PBA group and PE combined PBA(PE + PBA)group according to their will, 25 cases in each group. The levels of serum alanine aminotransferase(ALT),total bilirubin(TBIL),albumin(ALB),prothrom-bin time(PT),prothrombin activity(PTA),serum creatinine(SCr)and blood ammonia were compared among the three groups before and after treatment,and the adverse reactions were observed. Results There was no significant difference in serum ALT,TBIL,ALB and SCr levels among the three groups before treatment(P > 0. 05). The levels of serum ALT,TBIL and SCr after treatment were significantly lower than those before treatment in the three groups(P < 0. 05). The level of serum ALB af-ter treatment was significantly higher than that before treatment in the PE group and the PE + PBA group(P < 0. 05),but the level of serum ALB after treatment was significantly lower than that before treatment in the PBA group (P < 0. 05). There was no significant difference in serum ALT,TBIL and SCr levels among the three groups after treatment(P > 0. 05). The serum ALB levels in the PE group and the PE + PBA group was significantly higher than that in the PBA group after treatment(P <0. 05). There was no significant difference in serum ALB level between the PE group and the PE + PBA group after treatment (P > 0. 05). There was no significant difference in the PT,PTA and blood ammonia level among the three groups before treat-ment(P > 0. 05). Compared with before treatment,the PT shortened significantly after treatment,the PTA increased significant-ly,and the blood ammonia level decreased significantly in the three groups(P < 0. 05). Compared with the PBA group,the PT shortened significantly,the PTA increased significantly,and the blood ammonia level decreased significantly in the PE group and the PE + PBA group after treatment(P < 0. 05). There was no significant difference in PT,PTA and blood ammonia level between the PE group and the PE + PBA group after treatment(P > 0. 05). The plasma consumption of patients in the PE group and the PE + PBA group was(2908. 11 ± 287. 91)and(1107. 24 ± 213. 67)mL respectively,the plasma consumption in the PE + PBA group was significantly less than that in the PE group(t = 23. 782,P < 0. 05). The treatment time of patients in the PE group,the PBA group and the PE + PBA group was(2. 90 ± 0. 87),(3. 02 ± 0. 77),(3. 22 ± 0. 69)h respectively;there was no significant difference in the treatment time among the three groups(F = 1. 881,P > 0. 05). The total effective rate in the PE group,the PBA group and the PE + PBA group was 64. 0％(16 / 25),56. 0％(14 / 25),64. 0％(16 / 25),respectively;there was no significant difference in the total effective rate among the three groups(χ2 = 7. 281,P > 0. 05). The incidence of eryth-ra,chill and rigor,numbness and convulsion,infection and errhysis in the PE group was 32. 0％(8 / 25),28. 0％(7 / 25), 16. 0％(4 / 25),8. 0％(2 / 25),8. 0％(2 / 25),respectively. The incidence of erythra,chill and rigor,numbness and convul-sion,infection and errhysis in the PBA group was 16. 0％(4 / 25),16. 0％(4 / 25),12. 0％(3 / 25),4. 0％(1 / 25),4. 0％(1 /25),respectively. The incidence of erythra,chill and rigor,numbness and convulsion,infection and errhysis in the PE + PBA group was 20. 0％(5 / 25),20. 0％(5 / 25),12. 0％(3 / 25),4. 0％(1 / 25)and 4. 0％(1 / 25),respectively. The incidence of erythra,chill and rigor,numbness and convulsion,infection and errhysis in the PBA group and the PE + PBA group was signifi-cantly lower than that in the PE group(P < 0. 05). There was no significant difference in the incidence of erythra,chill and rig-or,numbness and convulsion,infection and errhysis between the PBA group and the PE + PBA group(P > 0. 05). Conclusion PE combined with PBA is effective,safe and feasible in the treatment of HBV related liver failure,and it can reduce plasma consumption.