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目的进一步评价HB-H-6树脂吸附胆红素血浆灌流在治疗慢性肝病重度黄疸中的价值及最佳适用范围。方法选择2006年10月～2010年7月天津市第三中心医院94例不同病因慢性肝病重度黄疸患者,其中男性68例,女性26例;年龄29～76岁,中位年龄57岁。接受HB-H-6树脂吸附胆红素血浆灌流治疗,比较单次HB-H-6树脂吸附胆红素血浆灌流治疗前后血清胆红素变化;并探讨不同初始胆红素水平及初始凝血酶原活动度(PTA)水平对HB-H-6树脂吸附胆红素能力的影响。结果单次HB-H-6树脂吸附胆红素血浆灌流治疗前血清总胆红素(TBiL)、直接胆红素(DBiL)、间接胆红素(IBiL)分别为(387.80±183.08)、(238.66±103.52)、(127.23±62.00)μmol/L;治疗后分别为(291.80±135.58)、(183.10±76.29)、(92.85±54.25)μmol/L,血浆灌流治疗能显著降低治疗后血清TBiL、DBiL及IBiL的水平(P<0.01);单次HB-H-6树脂吸附胆红素血浆灌流治疗对TBiL、DBiL及IBiL的清除率分别为23.68%±9.14%、21.54%±9.90%及27.09%±16.84%,HB-H-6树脂对IBiL的吸附能力略强于TBiL及DBiL(P<0.01)。HB-H-6树脂吸附胆红素血浆灌流对不同层次的初始TBiL水平均有效,均能引起治疗后胆红素水平的显著降低(P<0.01);初始TBiL水平越高,HB-H-6树脂清除胆红素的绝对值越高(P<0.01);对初始TBiL水平在200μmol/L以上HB-H-6树脂吸附能力明显高于初始TBiL水平在200μmol/L以下时(P<0.01)。HB-H-6树脂吸附胆红素的能力不受初始PTA影响;无明显不良反应。结论 HB-H-6树脂吸附胆红素血浆灌流作为黄疸的人工肝治疗方法之一,安全有效,且适用于TBiL浓度200μmol/L以上的重度黄疸患者。
Objective To further evaluate the value and optimal application of HB-H-6 resin-adsorbed bilirubin plasma perfusion in the treatment of severe jaundice with chronic liver disease. Methods From October 2006 to July 2010, 94 patients with severe hepatitis with chronic liver disease of different etiology from the Third Central Hospital of Tianjin were enrolled. Among them 68 were males and 26 females. The patients were 29 to 76 years old with a median age of 57 years. HB-H-6 resin adsorption bilirubin plasma perfusion therapy, a single HB-H-6 resin adsorption bilirubin plasma perfusion before and after treatment of serum bilirubin; and explore the different initial bilirubin levels and initial thrombin Effect of PTA on Adsorption of Bilirubin on HB-H-6 Resin. Results Serum total bilirubin (TBiL), direct bilirubin (DBiL) and indirect bilirubin (IBiL) before HB-H-6 resin-loaded bilirubin plasma perfusion were 387.80 ± 183.08 and (291.80 ± 135.58), (183.10 ± 76.29) and (92.85 ± 54.25) μmol / L after treatment were significantly lower than those in the control group (238.66 ± 103.52 and 127.23 ± 62.00 μmol / L, respectively) DBiL and IBiL (P <0.01). The clearance rates of TBiL, DBiL and IBiL for HB-H-6 resin-adsorbed bilirubin plasma perfusion were 23.68% ± 9.14%, 21.54% ± 9.90% and 27.09 % ± 16.84%. The adsorption capacity of HB-H-6 resin to IBiL was slightly stronger than that of TBiL and DBiL (P <0.01). HB-H-6 resin adsorption bilirubin plasma perfusion on the different levels of the initial TBiL levels are effective, can cause a significant reduction in bilirubin levels after treatment (P <0.01); the higher the initial TBiL level, HB-H- (P <0.01). The adsorption capacity of HB-H-6 resin with initial TBiL above 200 μmol / L was significantly higher than that with initial TBiL below 200 μmol / L (P <0.01) ). The ability of HB-H-6 resin to adsorb bilirubin is unaffected by initial PTA; no apparent adverse reactions. Conclusions HB-H-6 resin adsorption bilirubin plasma perfusion is safe and effective as one of the artificial liver therapy for jaundice, and is suitable for patients with severe jaundice with TBiL concentration above 200μmol / L.