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目的探讨拉米夫定(LVD)联合血浆置换(PE)在慢性乙型重型肝炎治疗中的作用及疗效评价。方法将慢性重型乙型肝炎患者分为治疗组24例,对照组25例,两组均给予促肝细胞再生、护肝、免疫调控及对症支持治疗,治疗组同时给予LVD+PE治疗。结果治疗组TBiL、ALT、ALB及PTA等生化指标于治疗后4周、12周恢复好转速度均优于对照组(P<0.05或P<0.01);治疗组HBV-DNA水平呈进行性下降趋势,12周HBV-DNA转阴率73.7%,显著高于对照组的16.7%(P<0.01);治疗组12周治愈好转率79.2%,显著高于对照组的48%(P<0.01)。结论早期诊断、及时应用LVD+PE治疗可显著提高慢性乙型重型肝炎治愈好转率,改善预后。
Objective To investigate the effect of lamivudine (LVD) combined with plasma exchange (PE) in the treatment of chronic severe hepatitis B and evaluate its curative effect. Methods Patients with chronic severe hepatitis B were divided into treatment group (n = 24) and control group (n = 25). Both groups were given hepatocyte regeneration, liver protection, immune regulation and symptomatic supportive treatment. The treatment group was treated with LVD + PE at the same time. Results The biochemical indexes such as TBiL, ALT, ALB and PTA in the treatment group were better than those in the control group (P <0.05 or P <0.01) at 4 weeks and 12 weeks after treatment, respectively. The HBV-DNA levels in the treatment group showed a trend of decline The negative conversion rate of HBV-DNA in 12 weeks was 73.7%, which was significantly higher than that in control group (16.7%, P <0.01). The therapeutic improvement rate was 79.2% in 12 weeks in treatment group, which was significantly higher than that in control group (48%, P <0.01). Conclusion Early diagnosis and prompt treatment with LVD + PE can significantly improve the cure rate of chronic type B severe hepatitis and improve the prognosis.