双重血浆分子吸附模式人工肝治疗乙肝相关慢加急性肝衰竭的疗效观察
|
摘要
目的探讨双重血浆分子吸附(DPMAS)模式人工肝治疗乙肝相关慢加急性肝衰竭(ACLF)早期患者的疗效。方法选取80例乙肝相关ACLF早期患者的临床资料。所有患者接受人工肝治疗,其中采取DPMAS模式40例、PE模式40例。比较两组患者治疗前后血TBil、肌酐(Cr)、总胆汁酸(TBA)、国际标准化比值(INR)、TNF-α、IL-6水平和终末期肝病模型(MELD)评分,观察不良反应,计算3个月存活率。结果两组患者治疗前血TBil、Cr、TBA、INR、TNF-α、IL-6水平及MELD评分比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者血TBil、Cr、TBA、TNF-α、IL-6水平及MELD评分均较治疗前明显降低(均P<0.05),其中TBil、TBA、TNF-α、IL-6水平为DPMAS组低于PE组(均P<0.05),MELD评分为DPMAS组高于PE组(P<0.05)。DPMAS组治疗前后INR比较,差异无统计学意义(P>0.05);PE组治疗后INR明显降低(P<0.05),且低于DPMAS组(P<0.05)。DPMAS组不良反应发生率低于PE组(P<0.05),3个月患者存活率高于PE组(P<0.05)。结论 DPMAS模式人工肝治疗乙肝相关ACLF的疗效优于PE模式,且治疗过程中不使用血浆,可作为临床早期患者的优先选择。
Objective To evaluate the efficacy of double plasma molecular adsorption(DPMAS) model for the treatment of hepatitis B-associated acute-on-chronic liver failure. Methods Eighty patients with hepatitis B-associated acute-onchronic liver failure undergoing artificial liver therapy were randomly assigned to receive DPMAS model(n=40, DPMAS group) or plasma exchange model(n=40, PE group). The total bilirubin(TBil), creatinine(Cr), total bile acid(TBA), international normalized ratio(INR) and tumor necrosis factor-α(TNF-α), interleukin 6(IL-6), model for end-stage liver disease(MELD) score were compared before and after treatment in and between two groups. The adverse reactions and the 3-month survival rate were observed in two groups. Results There was no significant difference in TBil, Cr, TBA, INR, TNF-α, IL-6 levels and Meld scores before treatment between the two groups(P >0.05). After treatment, the levels of Tbil, Cr, TBA, TNF-α, IL-6 and MELD scores were significantly decreased in both groups(P<0.05).While the levers of TBil, TBA, TNF-α, IL-6 in DPMAS group were significantly lower and MELD score was significantly higher than those in PE group(P<0.05). There was no significant difference in INR before and after treatment in DPMAS group(P >0.05), however, the INR in PE group was decreased after treatment(P<0.05). The incidence of adverse reactions in DPMAS group was significantly lower than that of PE group(7.5% vs 25.0%, P<0.05), and the 3-months survival rate of DPMAS group was significantly higher than that of PE group(75.0%vs 52.5%, P<0.05). Conclusion The efficacy of DPMAS model for treatment of hepatitis B-associated acute-on-chronic liver failure is better than that of PE model.
Objective To evaluate the efficacy of double plasma molecular adsorption(DPMAS) model for the treatment of hepatitis B-associated acute-on-chronic liver failure. Methods Eighty patients with hepatitis B-associated acute-onchronic liver failure undergoing artificial liver therapy were randomly assigned to receive DPMAS model(n=40, DPMAS group) or plasma exchange model(n=40, PE group). The total bilirubin(TBil), creatinine(Cr), total bile acid(TBA), international normalized ratio(INR) and tumor necrosis factor-α(TNF-α), interleukin 6(IL-6), model for end-stage liver disease(MELD) score were compared before and after treatment in and between two groups. The adverse reactions and the 3-month survival rate were observed in two groups. Results There was no significant difference in TBil, Cr, TBA, INR, TNF-α, IL-6 levels and Meld scores before treatment between the two groups(P >0.05). After treatment, the levels of Tbil, Cr, TBA, TNF-α, IL-6 and MELD scores were significantly decreased in both groups(P<0.05).While the levers of TBil, TBA, TNF-α, IL-6 in DPMAS group were significantly lower and MELD score was significantly higher than those in PE group(P<0.05). There was no significant difference in INR before and after treatment in DPMAS group(P >0.05), however, the INR in PE group was decreased after treatment(P<0.05). The incidence of adverse reactions in DPMAS group was significantly lower than that of PE group(7.5% vs 25.0%, P<0.05), and the 3-months survival rate of DPMAS group was significantly higher than that of PE group(75.0%vs 52.5%, P<0.05). Conclusion The efficacy of DPMAS model for treatment of hepatitis B-associated acute-on-chronic liver failure is better than that of PE model.
引文
[1]杨博,李肖甫.血液病患儿过敏性输血反应与过敏史关系研究[J].中国输血杂志,2017,36(12):1360-1362.
[2]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会,重型肝炎与人工肝学组.肝衰竭指南(2012年版)[J].中华肝脏病杂志,2013,21(3):177-183.DOI:10.3760/cma.j.issn.1007-3418.2013.03.006.
[3]李兰娟.人工肝脏[M].2版.杭州:浙江大学出版社,2012:348-349.
[4]叶一农,高志良.乙型肝炎肝衰竭发生机制中的三重打击[J].传染病信息,2009,22(5):276-279.DOI:10.3969/j.issn.1007-8134.2009.05.006.
[5]罗光成,黄云丽,闫惠平,等.HBV相关慢加急肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29(1):26-30.DOI:10.3969/j.is s n.1673-8640.2014.01.006.
[6]田光敏,刘鹏.枯否细胞在肝衰竭中的作用及机制研究进展[J].医学信息,2017,30(2):18-20.DOI:10.3969/j.issn.1006-1959.2017.02.012.
[7]伍红艳,颜华东.全身炎症反应综合征对慢性乙型重型肝炎预后的影响研究[J].现代实用医学,2015,27(2):231-233.DOI:10.3969/j.issn.1671-0800.2014.02.057.
[8]胡铧东,刘寿荣.人工肝支持系统治疗肝衰竭的进展及其对细胞因子的影响[J].中国现代医生,2016,54(24):163-168.
[9]高梦丹,赵艳.慢加急性肝衰竭息者预后相关免疫因素研究进展[J].临床肝胆病,2017,33(12):2462-2465.DOI:10.3969/j.issn.1001-5256.2017.12.047.
[10]黄建荣.人工肝在慢加急性肝衰竭中的应用现状及展望[J].中华肝病杂志,2016,24(12):935-939.DOI:10.3760/cma.j.issn.1007-3418.2016.12.013.
[11]李兰娟.肝衰竭与李氏人工肝进展[J].中华临床感染病杂志,2017,10(2):92-94.DOI:10.3760/c ma.j.is s n.1674-2397.2017.02.002.
[12]吴李贤,叶一农,何宏亮,等.血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效分析[J].热带医学杂志,2014,14:481-484.
[13]唐碧波,戴丽星,胡东辉,等.血浆置换与血浆灌流联合治疗肝衰竭的疗效及对炎症因子及肝功能的影响[J].代生物医学进展,2017,17(25):4904-4907.DOI:10.13241/j.c nki.p mb.2017.25.025.
[2]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会,重型肝炎与人工肝学组.肝衰竭指南(2012年版)[J].中华肝脏病杂志,2013,21(3):177-183.DOI:10.3760/cma.j.issn.1007-3418.2013.03.006.
[3]李兰娟.人工肝脏[M].2版.杭州:浙江大学出版社,2012:348-349.
[4]叶一农,高志良.乙型肝炎肝衰竭发生机制中的三重打击[J].传染病信息,2009,22(5):276-279.DOI:10.3969/j.issn.1007-8134.2009.05.006.
[5]罗光成,黄云丽,闫惠平,等.HBV相关慢加急肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29(1):26-30.DOI:10.3969/j.is s n.1673-8640.2014.01.006.
[6]田光敏,刘鹏.枯否细胞在肝衰竭中的作用及机制研究进展[J].医学信息,2017,30(2):18-20.DOI:10.3969/j.issn.1006-1959.2017.02.012.
[7]伍红艳,颜华东.全身炎症反应综合征对慢性乙型重型肝炎预后的影响研究[J].现代实用医学,2015,27(2):231-233.DOI:10.3969/j.issn.1671-0800.2014.02.057.
[8]胡铧东,刘寿荣.人工肝支持系统治疗肝衰竭的进展及其对细胞因子的影响[J].中国现代医生,2016,54(24):163-168.
[9]高梦丹,赵艳.慢加急性肝衰竭息者预后相关免疫因素研究进展[J].临床肝胆病,2017,33(12):2462-2465.DOI:10.3969/j.issn.1001-5256.2017.12.047.
[10]黄建荣.人工肝在慢加急性肝衰竭中的应用现状及展望[J].中华肝病杂志,2016,24(12):935-939.DOI:10.3760/cma.j.issn.1007-3418.2016.12.013.
[11]李兰娟.肝衰竭与李氏人工肝进展[J].中华临床感染病杂志,2017,10(2):92-94.DOI:10.3760/c ma.j.is s n.1674-2397.2017.02.002.
[12]吴李贤,叶一农,何宏亮,等.血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效分析[J].热带医学杂志,2014,14:481-484.
[13]唐碧波,戴丽星,胡东辉,等.血浆置换与血浆灌流联合治疗肝衰竭的疗效及对炎症因子及肝功能的影响[J].代生物医学进展,2017,17(25):4904-4907.DOI:10.13241/j.c nki.p mb.2017.25.025.