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目的分析血浆置换治疗慢性重型肝炎影响疗效的因素。方法回顾性分析血浆置换治疗慢性重型肝炎86例的临床资料,对影响临床疗效的因素进行分析。结果49例患者痊愈或明显好转,存活率为56.98%;37例病情恶化或死亡,病死率43.02%。死亡组年龄大于存活组(P<0.01);在肝硬化基础上发生的重型肝炎患者血浆置换的疗效低于在慢性肝炎基础上发生的重型肝炎(P<0.01);存活组凝血酶原活动度(PTA)、血清总胆固醇、甲胎蛋白及白蛋白水平高于死亡组,而血清总胆红素、内毒素水平低于死亡组(P<0.01);血浆置换治疗慢性重型肝炎早、中期患者疗效高于晚期患者疗效(P<0.01),慢性重型肝炎存在的并发症也影响血浆置换的疗效。讨论血浆置换的疗效与患者的年龄、治疗前的血清总胆红素、凝血酶原活动度(PTA)、血清总胆固醇、甲胎蛋白、白蛋白及内毒素水平有关。血浆置换治疗后胆红素水平反跳明显、PTA恢复不明显或甚至更低者的疗效差。我们认为血浆置换治疗>5或6次后病情仍未改善,血清胆红素水平下降不明显或反跳幅度明显、PTA恢复不明显或甚至更低者,有条件者应尽早施行肝移植术。
Objective To analyze the effect of plasma exchange on the treatment of chronic severe hepatitis. Methods The clinical data of 86 patients with chronic severe hepatitis treated by plasma exchange were retrospectively analyzed, and the factors influencing the clinical curative effect were analyzed. Results 49 patients recovered or significantly improved, the survival rate was 56.98%; 37 cases of deterioration or death, the case fatality rate was 43.02%. (P <0.01). The efficacy of plasma exchange in patients with severe hepatitis based on cirrhosis was lower than that of patients with severe hepatitis based on chronic hepatitis (P <0.01). The activity of prothrombin in survivors (PTA), serum total cholesterol, alpha-fetoprotein and albumin were higher than those in the death group, while serum total bilirubin and endotoxin levels were lower than those in the death group (P <0.01). Plasma exchange was used to treat patients with early and middle stage chronic severe hepatitis The curative effect is higher than that of advanced patients (P <0.01). The complications of chronic severe hepatitis also affect the curative effect of plasma exchange. Discussion The efficacy of plasma exchange is related to the patient’s age, pretreatment serum total bilirubin, prothrombin activity (PTA), serum total cholesterol, alpha-fetoprotein, albumin, and endotoxin levels. Bilirubin levels rebounded significantly after plasma exchange therapy, PTA recovery is not obvious or even less effective. We believe that plasma exchange therapy> 5 or 6 times after the condition has not improved, serum bilirubin levels were not significantly decreased or significant reversal, PTA recovery was insignificant or even lower, the conditional implementation of liver transplantation should be as soon as possible.