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目的探讨多次血浆置换治疗重型乙型肝炎的临床效果。方法对63例重型乙型肝炎患者反复进行血浆置换治疗,比较置换前后患者症状、总胆红素(TBIL)、凝血酶原活动度(PTA)的变化和有效好转率。结果治疗后患者症状明显减轻,TBIL、PTA均有不同程度的改善,治疗前后TBIL分别为(429.56±143.65)μmol/L和(268.93±92.86)μmol/L,治疗前后PTA分别为(31.94±12.02)%和(52.36±12.15)%。63例患者中28例好转,35例无效(包括肝移植或死亡),好转组TBIL、PTA在治疗结束第3dTBIL反弹幅度均较无效组差异有统计学意义(P<0.05),治疗好转组患者在结束治疗第3dTBIL反弹至原来水平的(0.78±0.23),而无效组反弹至原来水平的(0.98±0.19),治疗好转组患者在结束治疗第3dPTA能保持在血浆置换后(0.81±0.23),而无效组为(0.58±0.19)。同时在多次血浆置换中治疗好转组TBIL平均数值呈现逐步下降趋势,而无效组显示无明显下降。结论人工肝血浆置换能显著改善患者临床症状及生化指标,监测TBIL及PTA的变化有助于决定是否多次行血浆置换治疗。
Objective To investigate the clinical effect of multiple plasma exchange in the treatment of severe hepatitis B. Methods Sixty - three patients with severe hepatitis B were treated by repeated plasma exchange. The changes of symptoms, total bilirubin (TBIL), prothrombin activity (PTA) and the effective rate of the patients before and after the replacement were compared. Results After treatment, the symptoms of patients were relieved. The TBIL and PTA were improved to some extent. The TBIL before and after treatment were (429.56 ± 143.65) μmol / L and (268.93 ± 92.86) μmol / L respectively, PTA was 31.94 ± 12.02 )% And (52.36 ± 12.15)%. Among the 63 patients, 28 improved and 35 were ineffective (including liver transplantation or death). The TBIL and PTA in the improved group were significantly different from those in the ineffective group on the 3rd day (P <0.05) (0.78 ± 0.23) at the end of treatment and (0.78 ± 0.23) at the end of the treatment, while the ineffective group rebounded to the original level (0.98 ± 0.19). The patients in the remission treated group maintained the plasma 3dPTA at the end of treatment (0.81 ± 0.23) , While the invalid group was (0.58 ± 0.19). At the same time, the average value of TBIL in treatment improvement group showed a gradual downward trend in multiple plasma exchange, while the invalid group showed no significant decline. Conclusion Artificial liver plasma exchange can significantly improve the clinical symptoms and biochemical indicators of patients, monitoring TBIL and PTA changes help determine whether multiple plasma exchange therapy.