摘要
目的探讨人工肝治疗后总胆红素反弹率的影响因素及对预后的预测作用,比较血浆置换(PE)和持续缓慢血液透析滤过(CHDF)治疗中、晚期慢性重型肝炎的疗效。方法血浆置换(PE)为A组59例,中期28例,晚期31例。血浆置换联合持续缓慢血液透析滤过(PE+CHDF)为B组86例,中期39例,晚期47例。两组病例均合并有不同程度的并发症,观察两组病例人工肝治疗后总胆红素清除率、总胆红素反弹率及预后等,B组同时观察治疗前后电解质变化。结果治疗后总胆红素反弹率有影响意义的因素为治疗方法(P<0.05)、治疗前的诊断(病情轻重)(P<0.05),两者偏回归系数β分别为-0.116,0.043。治疗后总胆红素反弹率与预后之间进行等级相关分析,两者有正相关性,相关系数为r=0.324(P<0.05),治愈或好转患者人工肝治疗后总胆红素反弹率均值为(31.88±21.07)%,自动出院或转肝移植或死亡组患者人工肝治疗后总胆红素反弹率均值为(45.17±22.65)%。在两组各诊断的构成比相当(即病情相当)的情况下,A,B组总胆红素清除率为(39.73±12.64)%,(38.05±9.89)%,两组比较差别无统计学意义(P=0.416);两组治疗后总胆红素反弹率分别(45.22±20.23)%,(31.03±19.05)%,差别有统计学意义(P<0.001)。B组能有效改善肝性脑病、纠正低钾血症、降低合并肝肾综合征患者的血肌酐水平。B组有效率70.93%优于A组有效率50.84%。结论人工肝治疗后,对总胆红素反弹率有影响意义的因素为治疗方法、治疗前的诊断(病情轻中重),可以通过总胆红素反弹率初步推测患者的预后,PE+CHDF联合治疗慢性乙型重型肝炎安全有效。
Objective To study the influencing factors on the rebound rate of total bidirubin after artificial liver support system（ALSS） and its prognostic value and to compare the difference between continuous hemediafiltrafion（CHDF） plus plasma exchange（PE） and simply PE. Methods All patients suffered from severe hepatitis B in the study. 59 cases were treated with PE（A group）,86 cases were treated with PE＋ CHDF（B group）,All the patients had complications. After ALSS, the clearing rate, rebound rate of total bilirubin and prognosis were studied. The change of electrolytes was also studied in group B. Results The influencing factors on the rebound rate of total bilirubin were treatment（ P〈0.05） ,diagnose（ P〈0.05）, with a partial regression coegicient β of -0.116 and 0.043 respectively. There was rank correlation between rebound rate of total bilirubin and prognosis, with positive coeffiecient （r） of 0. 324 （ P 〈0. 05）. The rebound rate of total bilirubin was （31.88±21.07） % in the improved or cured group and（45.17± 22.65） % in the departed, liver transplantation or death group. The cleating rate of total bilirubin was（39.73±12.64） % and （38.05± 9.89）% in group A and B respectively. There was no significant difference between the two groups （ P = 0. 416） ; The rebound rate of total bilirubin was （ 45.22 ± 20.23 ） % and （ 3 1.03±19.05 ） %, with significant difference（ P 〈 0.001 ）. The incidence Hepatic encephalopathy and hypohalema and the serum Cr were lower in the patients with liver- renal syndrome in group B. Condusion The influencing factors on the rebound rate of total bilirubin after ALSS are treatment method and diagnosis. The prognosis of the patients can be predicted by the rebound rate. The combined treatment is safer and mere effective.
出处
《广东医学》
CAS
CSCD
北大核心
2005年第9期1211-1213,共3页
Guangdong Medical Journal
基金
广东省重点科技攻关资助项目(编号:99No
4905G)
