临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2014年
10期
1015-1019
,共5页
肝功能衰竭%肝,人工%血浆置换
肝功能衰竭%肝,人工%血漿置換
간공능쇠갈%간,인공%혈장치환
liver failure%liver,artifical%plasma exchange
目的：观察血浆置换术（PE）治疗肝衰竭的疗效。方法回顾性分析2012年1月至2013年6月收治的肝衰竭患者的临床资料，PE 组33例肝衰竭患者在内科综合治疗基础上加用血浆置换治疗，对照组30例肝衰竭患者予内科综合治疗，观察两组患者治疗2周后临床症状、并发症发生情况、肝功能生化指标的变化等，随访治疗后3个月内病情转归情况并分析影响疗效的因素。实验检测数据用均数±标准差（x ±s）表示，计量资料用 t 检验进行比较，计数资料采用χ2检验或 Fisher 确切概率法。结果予血浆置换治疗后，患者乏力、纳差、腹胀等临床症状明显改善，血清中 ALT、TBil 水平较治疗前降低[（390．48±536．52）U /L vs （81．03±47．58）U /L；（479．27±130．01）μmol /L vs （244．64±151．05）μmol /L，P 值均＜0．01]，Alb、胆固醇（CHO）、凝血酶原活动度（PTA）水平较治疗前升高[（33．06±5．42）g/L vs （35．24±3．68）g/L；（2．50±1．24）mmol /L vs （3．59±0.86）mmol /L；（34．16±5．33）％vs （73．98±27．23）％，P 值均＜0．01]，对照组治疗后 ALT、TBil、Alb、CHO、PTA 水平较治疗前差异无统计学意义（P ＞0．05）；PE 组患者好转率明显高于对照组（χ2＝8．276，P ＜0．01），而病死率低于对照组（χ2＝13．258，P ＜0．01）；PE 治疗效果与治疗前 TBil 水平、并发症、胆酶分离、年龄≥40岁有关（P ＜0．05），TBil、胆酶分离是影响 PE 疗效的独立危险因素（P ＜0．05，OR 值分别为1．01、8.75）；术中共发生不良反应8例次，予对症处理后均可好转并完成治疗。结论PE 治疗肝衰竭安全有效，有临床推广价值。TBil、胆酶分离是影响 PE 疗效的独立危险因素。
目的：觀察血漿置換術（PE）治療肝衰竭的療效。方法迴顧性分析2012年1月至2013年6月收治的肝衰竭患者的臨床資料，PE 組33例肝衰竭患者在內科綜閤治療基礎上加用血漿置換治療，對照組30例肝衰竭患者予內科綜閤治療，觀察兩組患者治療2週後臨床癥狀、併髮癥髮生情況、肝功能生化指標的變化等，隨訪治療後3箇月內病情轉歸情況併分析影響療效的因素。實驗檢測數據用均數±標準差（x ±s）錶示，計量資料用 t 檢驗進行比較，計數資料採用χ2檢驗或 Fisher 確切概率法。結果予血漿置換治療後，患者乏力、納差、腹脹等臨床癥狀明顯改善，血清中 ALT、TBil 水平較治療前降低[（390．48±536．52）U /L vs （81．03±47．58）U /L；（479．27±130．01）μmol /L vs （244．64±151．05）μmol /L，P 值均＜0．01]，Alb、膽固醇（CHO）、凝血酶原活動度（PTA）水平較治療前升高[（33．06±5．42）g/L vs （35．24±3．68）g/L；（2．50±1．24）mmol /L vs （3．59±0.86）mmol /L；（34．16±5．33）％vs （73．98±27．23）％，P 值均＜0．01]，對照組治療後 ALT、TBil、Alb、CHO、PTA 水平較治療前差異無統計學意義（P ＞0．05）；PE 組患者好轉率明顯高于對照組（χ2＝8．276，P ＜0．01），而病死率低于對照組（χ2＝13．258，P ＜0．01）；PE 治療效果與治療前 TBil 水平、併髮癥、膽酶分離、年齡≥40歲有關（P ＜0．05），TBil、膽酶分離是影響 PE 療效的獨立危險因素（P ＜0．05，OR 值分彆為1．01、8.75）；術中共髮生不良反應8例次，予對癥處理後均可好轉併完成治療。結論PE 治療肝衰竭安全有效，有臨床推廣價值。TBil、膽酶分離是影響 PE 療效的獨立危險因素。
목적：관찰혈장치환술（PE）치료간쇠갈적료효。방법회고성분석2012년1월지2013년6월수치적간쇠갈환자적림상자료，PE 조33례간쇠갈환자재내과종합치료기출상가용혈장치환치료，대조조30례간쇠갈환자여내과종합치료，관찰량조환자치료2주후림상증상、병발증발생정황、간공능생화지표적변화등，수방치료후3개월내병정전귀정황병분석영향료효적인소。실험검측수거용균수±표준차（x ±s）표시，계량자료용 t 검험진행비교，계수자료채용χ2검험혹 Fisher 학절개솔법。결과여혈장치환치료후，환자핍력、납차、복창등림상증상명현개선，혈청중 ALT、TBil 수평교치료전강저[（390．48±536．52）U /L vs （81．03±47．58）U /L；（479．27±130．01）μmol /L vs （244．64±151．05）μmol /L，P 치균＜0．01]，Alb、담고순（CHO）、응혈매원활동도（PTA）수평교치료전승고[（33．06±5．42）g/L vs （35．24±3．68）g/L；（2．50±1．24）mmol /L vs （3．59±0.86）mmol /L；（34．16±5．33）％vs （73．98±27．23）％，P 치균＜0．01]，대조조치료후 ALT、TBil、Alb、CHO、PTA 수평교치료전차이무통계학의의（P ＞0．05）；PE 조환자호전솔명현고우대조조（χ2＝8．276，P ＜0．01），이병사솔저우대조조（χ2＝13．258，P ＜0．01）；PE 치료효과여치료전 TBil 수평、병발증、담매분리、년령≥40세유관（P ＜0．05），TBil、담매분리시영향 PE 료효적독립위험인소（P ＜0．05，OR 치분별위1．01、8.75）；술중공발생불량반응8례차，여대증처리후균가호전병완성치료。결론PE 치료간쇠갈안전유효，유림상추엄개치。TBil、담매분리시영향 PE 료효적독립위험인소。
Objective To investigate the clinical efficacy of plasma exchange (PE)in the treatment of liver failure.Methods A retro-spective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hos-pital.Thirty -three patients in PE group received PE in addition to medical comprehensive treatment,and 30 patients in control group were treated with medical comprehensive treatment.Clinical symptoms,complications,and the changes in biochemical markers of liver function were observed after 2 weeks of treatment,post -treatment outcomes were evaluated by 3 -month followed -up,and the influential factors for efficacy were analyzed.Experimental data were expressed as mean ±standard deviation,continuous data were compared by t test,and cate-gorical data were analyzed by chi -square test or Fisher′s exact test.Results Symptoms such as fatigue,poor appetite,and abdominal dis-tension were significantly relieved after PE.Post -treatment serum alanine aminotransferase (ALT)and total bilirubin (TBil)levels were significantly lower compared with pre -treatment levels (390.48 ±536.52 U /L vs 81.03 ±47.58 U /L and 479.27 ±130.01 μmol /L vs 244.64 ±151.05 μmol /L,P <0.005),whereas post -treatment levels of albumin (Alb)and cholesterol (CHO)and prothrombin activity (PTA)were significantly higher than those measured before the treatment (33.06 ±5.42 g/L vs 35.24 ±3.68 g/L,2.50 ±1.24 mmol /L vs 3.59 ±0.86 mmol /L,and 34.16% ±5.33% vs 73.98% ±27.23%,P <0.005).No significant differences were identified between pre-and post -treatment levels of ALT,TBil ,Alb,CHO,and PTA (P >0.05).Patients in PE group had a significantly higher improve-ment rate (χ2 =8.276,P <0.005)and a significantly lower mortality rate (χ2 =13.258,P <0.005)compared with the control group.The efficacy of PE was found to be correlated with pre -treatment TBil level,complications,bilirubin enzyme separation,and age ≥40 years (P <0.05).TBil and bilirubin enzyme separation were independent risk factors affecting the efficacy of PE (P <0.05,OR =1.01 and 8.75).Adverse reactions occurred in 8 cases during PE treatment,and disappeared after symptomatic treatment.Conclusion PE is a safe and effective treatment for liver failure,and holds promise for clinical application.TBil level and bilirubin enzyme separation are independ-ent risk factors affecting the efficacy of PE.
