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目的应用终末期肝病模型(MELD)评分系统预测血浆置换(PE)治疗后重型肝炎患者的预后。方法160例重型肝炎患者随机分为PE组与对照组,应用MELD评分系统对每个患者进行评分,比较两组患者病死率和治疗前后的临床生化指标,探讨与MELD评分的关系。结果MELD分值在30～39的患者PE后总胆红素(TBIL)、凝血酶原时间国际标准化比值(INR)、MELD评分分别为(379．4±40．4)μmol/L、(2．5±0．2)和(30．8±3．8);明显低于治疗前的(509．7±64．6)μmol/L、(3．5±0．3)和(37．3±3．5),差异有统计学意义(P＜0．05)。PE组患者的病死率为50．0%,明显低于对照组的86．7%,差异有统计学意义(P＜0．01)。MELD分值≥40的患者PE后的TBIL、INR及MELD评分分别为(595．6±61．5)μmol/L、(3．8±0．4)、(39．8±3．50),明显低于治疗前的(650．4±66．3)μmol/L、(4．4±0．60)、(45．2±4．2),差异有统计学意义(P＜0．05)。PE组患者病死率为91．2%,与对照组的100%相比,差异无统计学意义(P＞0．05)。结论PE通过降低重型肝炎患者的TBIL、INR、MELD评分,改善肝脏功能。血浆置换可降低MELD分值在30～39之间的重型肝炎患者的病死率,但不能降低MELD分值≥40的患者的病死率。
Objective To predict the prognosis of patients with severe hepatitis after plasma exchange (PE) therapy by using the end-stage liver disease (MELD) scoring system. Methods One hundred and sixty patients with severe hepatitis were randomly divided into PE group and control group. MELD score system was used to evaluate each patient. The case fatality rate and clinical biochemical indexes before and after treatment were compared to explore the relationship with MELD score. Results The total serum bilirubin (TBIL), international normalized ratio of prothrombin time (MEL) and MELD score of MELD score of 30 ~ 39 were (379.4 ± 40.4) μmol / L, (2 .5 ± 0.2) and (30.8 ± 3.8), respectively, which were significantly lower than those before treatment (509.7 ± 64.6) μmol / L, (3.5 ± 0.3) and 3 ± 3.5), the difference was statistically significant (P <0.05). The mortality of patients in PE group was 50.0%, which was significantly lower than that in control group (86.7%, P <0.01). The TBIL, INR and MELD scores of PE with MELD score≥40 were (595.6 ± 61.5) μmol / L, (3.8 ± 0.4) and (39.8 ± 3.50) , Which was significantly lower than that before treatment (650.4 ± 66.3) μmol / L, (4.4 ± 0.60) and (45.2 ± 4.2), respectively, with significant difference (P <0. 05). The mortality of patients in PE group was 91.2%, which was not significantly different from that in control group (P> 0.05). Conclusions PE can improve liver function by reducing TBIL, INR, MELD scores in patients with severe hepatitis. Plasma exchange can reduce mortality in patients with severe hepatitis with MELD scores between 30 and 39, but not in patients with MELD scores ≥40.