摘要
目的:探讨终末期肝病模型(model of end-stage liver disease,MELD)评分对乙型肝炎病毒(hepatitis B virus,HBV)相关性肝衰竭患者选择不同人工肝方式,如血浆置换(plasma exchange,PE)、双重血浆分子吸附(double plasma molecular adsorption system,DPMAS)、血浆置换联合双重血浆分子吸附(PE+DPMAS)治疗的指导意义。方法:回顾性分析210例HBV相关性肝衰竭患者临床资料,将所有患者按照入院时MELD值分成3个区间,即MELD<30、30≤MELD<40和MELD≥40,区间内患者根据人工肝方式不同分为3组:PE组、DPMAS组和PE+DPMAS组,比较不同MELD区间内3组人工肝治疗前后的实验室指标、MELD评分、4周有效率及3个月病死率的变化情况。结果:(1)在所有MELD区间,3组患者治疗前后丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、总胆红素(total bilirubin,TBIL)、MELD分值明显降低(P<0.05),仅在30≤MELD<40区间,PE+DPMAS组TBIL下降率和MELD下降值最高,存在统计学差异(P<0.01),其余区间组间差异无统计学意义;(2)所有MELD区间,PE+DPMAS组、PE组凝血酶原活动度(prothrombin activity,PTA)升高,2组间差异无统计学意义;而DPMAS组PTA降低,与PE+DPMAS组、PE组存在统计学差异(P<0.01);(3)3组患者治疗前后肌酐(creatinine,Cr)变化不明显,组间差异无统计学意义(P>0.05);(4)MELD<30区间,3组之间4周有效率比较无统计学差异(P>0.05),PE组3个月病死率最高,差异有统计学意义(P<0.05);30≤MELD<40区间,PE+DPMAS组有效率最高(P<0.05),病死率最低(P<0.01),差异有统计学意义(P<0.01);MELD≥40区间,3组之间有效率及病死率比较,差异均无统计意义(P>0.05)。结论:MELD评分系统可用于指导肝衰竭患者人工肝方式的选择,MELD<30的肝衰竭患者,人工肝方式优先选用DPMAS;30≤MELD<40的肝衰竭患者,选用PE+DPMAS方式疗效更佳,而对于MELD≥40的肝衰竭患者,所有人工肝治疗方式效果均欠佳,应尽早行肝移植术。
Objective:To explore the guiding significance of model for end-stage liver disease(MELD)score in patients with hepatitis B virus(HBV)-related liver failure choosing different ways of artificial liver :plasma exchange(PE),double plasma molecular adsorption system(DPMAS)and PE+DPMAS. Methods:The clinical data of 210 patients with HBV-related liver failure were analyzed retrospectively. All patients were divided into three intervals according to the MELD value at admission:MELD<30,30≤MELD<40 and MELD≥40. Patients in each interval were divided into three groups according to different ways of artificial liver:the PE group,the DPMAS group and the PE + DPMAS group. Changes of laboratory indexes,MELD score,4-week effective rate and 12-week mortality rate before and after treatment in three MELD groups were compared. Results:(1) In all MELD intervals,the ALT,AST,TBIL and MELD scores in three groups before and after treatment were significantly decreased(P <0.05). Only in the 30 ≤MELD <40 interval,the decrease rate of TBIL and MELD decrease in the PE +DPMAS group were was the highest,with statistical difference(P<0.01),while there was no significant difference between intergroups in the other two MELD intervals.(2) In all MELD intervals,the PTA in the PE+DPMAS group and the PE group was increased and the difference between two groups was not statistically significant. PTA in the DPMAS group was decreased,with statistical significance(P<0.01).(3)In all MELD intervals,there was no significant change in creatinine(Cr)before and after treatment,with no significant difference among three groups(P>0.05).(4)In the MELD<30 interval,the efficiency of 4-week among three groups was not statistically significant(P>0.05),and PE group had the highest mortality at 12 week(P<0.05). In the 30≤MELD<40 interval,the PE+DPMAS group had the highest efficiency(P<0.05)and the lowest case fatality(P<0.01),and the difference was statistically significant;in the MELD≥40 interval,there was no significant difference among three groups in the efficiency and mortality(P>0.05). Conclusion:MELD score can be used for choosing artificial liver in patients with HBV-related liver failure. Patients in MELD<30 interval,prefer to DPMAS,while patients with liver failure in30≤MELD<40 interval prefer to PE+DPMAS. But for patients in MELD≥40 interval,all artificial liver treatment are poor,therefore,liver transplantation should be performed as soon as possible.
作者
蒋奕
王洪州
邓存良
刘冰
薛丽容
Jiang Yi;Wang Hongzhou;Deng Cunliang;Liu Bing;Xue Lirong(Department of Infectious Disease,Sichuan Micnvyang 404 Hospital;Department of Respiratory and Critical Medicine,Sichuan Science City Hospital;Department of Infectious Disease,The Affiliated Hospital of,Southwest Medical University)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2021年第10期1201-1205,共5页
Journal of Chongqing Medical University
基金
四川省卫计委科研课题资助项目(编号:18PJ342)。
关键词
乙型肝炎病毒相关性肝衰竭
人工肝
血浆置换
双重血浆分子吸附
终末期肝病模型
hepatitis B-related liver failure
artificial liver
plasma exchange
double plasma molecular adsorption system
model for end-stage liver disease
