临床经验CLINICALPRACTICE不同人工肝方法治疗乙型肝炎肝衰竭的疗效对比分析刘凤华，贺玉凯，李庆方，王思奎2013-07-08|19|■背景资料肝衰竭发摘凶险s进展迅速，若不进行必要的干预，生存率很低.在我国.引起肝衰竭的病因主要是乙型肝炎病毒(hepatitisBvirus,HBV),约占80%-85%・血浆置换(plasmaexchange,PE)与血浆胆红索吸附(plasmaspecificbilirubinadsorp・Cion.PBA)均为有效的治疗手段，但各有其局限性,组合应用人工肝技术成为必然选择.■同行评议者杨江华，副教授，皖南医学院弋矶山医院感染科刘风华，贺玉凯.李庆方•王思奎，聊城市人民医院感染科东省聊城市252000刘凤华，主治医师，主耍从书肝衰竭的临床治疗和人工肝方而的研究.作者贡献分布：此课题设计由王思奎与刘凤华完成；李庆方折导：刘凤华与贺玉凯皱贵临床资料收集.数据管理及统计分析；论文写佶由刘凤华完成；论文审校由王思奎完成.通讯作者:王思奎，教授，主任医师,252000,山东省聊城市东昌西路67号，聊城市人民医院感染科.wangskl966@sina电话:0635-8272630收稿日期:2013-04-29修回日期:2013-05-21接受日期:2013-05-25在线岀版日期:2013-07-08ComparativestudyofefficacyofdifferenttypesofartificiallivertreatmentsinmanagementofhepatitisB-associatedliverfailureFeng-HuaLiu,Yu-KaiHe,Qing-FangLi,S-KuiWangFeng-HuaLiu,Yu-KaiHe,Qing-FangLi,S-KuiWang,DepartmentofInfectiousDiseases・UaochengPeople'sHospitalLiaochcng252000.ShandongProvince,ChinaCorrespondenceto:Si-KuiWang,Professor,ChiefPhysi-cian,DepartmentofInfectiousDiseases,LiaochengPeople'sHospital,67DongchangWestRoad,Liaochcng252000.ShandongProvince,China・wnngskl966@sinaReceived:2013-04-29Revised:2013-05-21Accepted:2013-05-25Publishedonline:2013-07-08AbstractAIM:Toinvestigatetheclinicalefficacyofplas-maexchange(PE),plasmabilirubinadsorption(PBA),andPEcombinedwithPBAinthetreatmentofhepatitisB-associatedliverfailure.METHODS:Theclinicaldatafor150patientswithhepatitisB-associatedliverfailurewereret-rospectivelyanalyzed.Thesepatientswereran-domlydividedintoaPEgroup,aPBAgroup,andaPE+PBAgroup・Thevolumeofplasmaconsumedonce,theeffectiverate,liverfunction,alanineaminotransferase(ALT),totalbilirubin(TBIL),albumin(ALB),prothrombintime(PT),prothrombintimeactivity(PTA),creatinine(Cr)andplasmaammoniawererecordedbothbeforeandaftertreatmentandcomparedamongthethreegroups・Theincidenceofadversereactions山wasalsoobserved.RESULTS:ThetotaleffectiveratewashigherinthecombinationgroupthaninthePEgroupandPBAgroup(65.45%vs62.5%,59.58%),butthedifferencewasnotstatisticallysignificant(bothP>0.05).TBILwassignificantlydecreased4hoursaftertreatmentcomparedtopre-treatmentvaluesinthePE,PBAandcombinationgroups(410.3xmol/L±208.6xmol/Lvs292.5xmol/L±175.4ocmol/L,432.7xmol/L±242.5xmol/Lvs298.8xmol/L±201.7ccmol/L,468.2xmol/L±241.6xmol/Lvs288.5xmol/L±184.5xmol/L,allP<0.05),butthedeclineshowednosignifi-cantlystatisticaldifferenceamongthethreegroups.Aftertreatment,PTwassigrdficantlyshortenedandPTAwasincreasedinthecom-binationgroupandPEgroup(bothP<0.05),butthechangesshowednosignificantdiffer-encebetweenthetwogroups(bothP>0.05).InthePBAgroup,PTwasincreasedandPTAwasdecreasedaftertreatment,butthedifferenceswerenotsignificant(P>0.05).BloodammoniaandCrweresignificantlydecreasedinthethreegroupsofpatientsaftertreatment(allP<0.05),althoughtherewasnosignificantlystatisticaldifferenceamongthethreegroups・Noseriousadversereactionsoccurred.Thevolumeofplas-maconsumedoncewassignificantlylessinthecombinationgroupthaninthePEgroup(1107.1mL±212.3mLvs2911.5mL±352.3mL,P<0.05).CONCLUSION:PEcombinedwit...