【作者】 王凯； 赵显国； 李素珍； 王欣芳； 张蓓蕾； 于爱萍；

【Author】 Wang Kai Zhao Xianguo Li Suzhen. The center of Blood Purification,The First Affliated Hospital of Zhengzhou University,Zhengzhou 450052,China

【机构】 郑州大学第一附属医院血液净化中心；

【摘要】 目的:探讨非生物型组合人工肝血浆置换(PE)联合血液滤过(HF)治疗重型肝炎的临床疗效和机制。方法:58例重型肝炎患者在内科综合治疗的基础上给予 PE+HF 治疗,观察治疗前后临床表现, 监测治疗前后肝肾功能、凝血酶原活动度(PTA)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、内毒素、一氧化氮(NO)及中分子物质(MMS)水平的变化。并比较首次治疗时机的选择及治疗频度对人工肝治疗效果的影响。结果:重型肝炎患者经人工肝治疗后,意识障碍、黄疸、乏力、腹胀等症状明显改善,白蛋白、凝血酶原活动度(PTA)较治疗前明显提高(P<0.05),尿素氮(BUN)、总胆红素(Tbil)、 TNF-α、IL-6、内毒素、NO 及 MMS 水平明显下降((P<0.05～0.01))。首次治疗时期不同,好转率差异有显著性(早期78.9%、中期75%、晚期0;P<0.05);治疗2次以上者死亡率较仅治疗1次者低。结论: PE 与 HF 两种非生物型人工肝的有效组合,可以起到优势互补、相互弥补弊端的作用,对大、中、小分子量的毒素均有清除作用,是目前较为成熟、完整的肝脏替代疗法。掌握恰当的治疗时机和治疗频度,效果更佳。更多还原

【Abstract】 Objective To investigate the clinical efficacy as well as the mechanism of plasma exchange(PE) plus hemofiltration(HF)in the treatment of hepatitis gravis.Methods Fifty-eight patients suffering from hepatitis gravis were treated with PE plus HF on the basis of conventional therapy.The liver function,renal function, prothrombin activity(PTA),serum tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),endotoxine, nitrogen monoxide(NO),middle molecule substances(MMS)and clinical symptoms were observed.And the efficacy of artificial liver treatment on the different stages and intervals of hepatitis gravis were investigated.Results After the treatment,the clinical symptoms such as conscious disturbance,jaundice, debilitation,abdominal distention were better than before.The levels of serum albumin and PTA increased obviously(p<0.05).The levels of BUN,total bilirubin,TNF-α,IL-6,endotoxine,NO and MMS decreased significantly(p<0.05～0.01).There were significant differences of improvement rate treated with PE plus HF in different stages and different treatment frequences.(Early stage 78.9% vs mid-stage 75% vs late-stage 0).Conclusions PE plus HF are effectively combined.The complementary therapeutic method may significantly decrease the levels of pathologic components.PE plus HF is a kind of mature fill-in treatment by now.To treat in the early stage and appropriate times,clinical results will be better.更多还原