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目的探讨乙型肝炎病毒引起的慢性肝衰竭血浆置换治疗疗效的影响因素。方法选择2013年1月-2013年12月符合条件的慢加急性肝衰竭患者239例进行血浆置换,根据患者出院时转归分为有效和无效,对可能影响疗效的因素(年龄、病程、治疗前总胆红素、凝血酶原活动度、肝性脑病、肝肾综合征、治疗时应用的血浆种类)进行Logistic回归分析。结果多因素Logistic回归分析显示,年龄>46.68岁、病程>7 d、凝血酶原活动度<31.66%、合并肝肾综合征、合并2级以上肝性脑病是PE治疗肝衰竭无效的危险因素(P<0.05)。相对危险度依次为:5.924、6.816、11.427、50.352和3.489。结论对于乙型肝炎病毒引起的慢加急性肝衰竭患者建议及早进行血浆置换,常规合理地应用抗病毒药物治疗原发病,预防肝肾综合征和肝性脑病的发生,可提高PE治疗的有效率。
Objective To investigate the influencing factors of therapeutic effect of hepatitis B virus (HBV) -based plasmapheresis on chronic liver failure. Methods A total of 239 eligible patients with acute and severe acute liver failure who underwent PHA between January 2013 and December 2013 were divided into two groups based on the outcome of the discharge. The factors that may affect the efficacy (age, course of disease, treatment Pre-total bilirubin, prothrombin activity, hepatic encephalopathy, hepatorenal syndrome, plasma type used during treatment) were analyzed by Logistic regression. Results Multivariate logistic regression analysis showed that prothrombin activity was less than 31.66% at the age of 46.68 years and duration of disease> 7 days. Combined with hepatorenal syndrome and pooled grade 2 hepatic encephalopathy were risk factors of PE failure in treating liver failure P <0.05). The relative risks are 5.924, 6.816, 11.427, 50.352 and 3.489 respectively. Conclusions For patients with chronic and acute liver failure caused by Hepatitis B virus, it is suggested to use plasma exchange as early as possible, and routinely and rationally use antiviral drugs to treat the primary disease, prevent the occurrence of hepatorenal syndrome and hepatic encephalopathy and improve the treatment of PE effectiveness.