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目的探讨血浆透析滤过治疗HBV相关慢加急性肝衰竭(ACLF)的疗效及预后的影响因素。方法回顾性分析41例接受血浆透析滤过治疗的HBV相关ACLF患者的临床资料,根据患者的短期预后(随访3个月)分为存活组和死亡组,分析两组间的临床指标和实验室检查结果,采用卡方检验、t检验分析血浆透析滤过的疗效及影响预后的相关因素。结果 41例患者血浆透析滤过治疗前的PTA为(18.33±7.75)%、TBil为(445.66±209.67)μmol/L、MELD评分为(32.08±6.75)分,3次血浆透析滤过治疗后第3天,PTA为(29.20±15.07)%、TBil为(396.88±151.78)μmol/L、MELD评分为(29.67±7.70)分,治疗前后比较,差异有统计学意义(t值分别为-3.826、2.042、2.026,均P<0.05)。存活组12例,死亡组29例。存活组患者入院时合并肝硬化比例为16.7%,低于死亡组的68.9%(χ~2=7.351,P<0.05);存活组诊断为肝衰竭至行血浆透析滤过治疗的间隔时间为(2.58±0.67)d,明显短于死亡组的(6.07±4.38)d(t=-4.167,P<0.05);入院时存活组合并肝性脑病比例为83.3%,死亡组比例为96.6%,差异无统计学意义(χ~2=0.672,P>0.05);存活组急性肾损伤(AKI)II期及III期患者比例为8.3%,而死亡组为65.5%,差异有统计学意义(χ~2=8.711,P<0.05)。存活组患者3次血浆透析滤过治疗后第3天与治疗前相比,MELD评分下降(8.33±4.19)分、PTA增加(21.72±15.62)%,而死亡组患者与治疗前相比,MELD评分增加(0.55±6.66)分、PTA增加(6.38±17.47)%,两组比较,差异有统计学意义(t值分别为4.267、-2.633,均P<0.05)。结论血浆透析滤过治疗能改善HBV相关ACLF中晚期患者的肝功能及凝血功能;治疗前具有肝硬化基础、肝衰竭病程长、AKI分期高的患者预后差;治疗72 h后,PTA、MELD评分有显著改善的患者预后佳。
Objective To investigate the efficacy and prognosis of plasma dialytic filtration in the treatment of chronic hepatitis B and acute liver failure (ACLF) associated with HBV. Methods The clinical data of 41 patients with HBV-related ACLF undergoing hemodiafiltration were retrospectively analyzed. According to their short-term prognosis (followed up for 3 months), the patients were divided into survival group and death group. The clinical indexes and laboratory Check the results, the use of chi-square test, t test analysis of the therapeutic effect of plasma dialysis and prognosis related factors. Results The PTA was (18.33 ± 7.75)%, the TBil was (445.66 ± 209.67) μmol / L, the MELD score was (32.08 ± 6.75)) in 41 patients before hemodialysis filtration. 3 days, PTA was (29.20 ± 15.07)%, TBil was (396.88 ± 151.78) μmol / L and MELD was (29.67 ± 7.70) points respectively. The difference was statistically significant before and after treatment (t = -3.826, 2.042,2.026, all P <0.05). There were 12 survivors and 29 deaths. The survival rate of patients with liver cirrhosis at admission was 16.7%, lower than 68.9% of death patients (χ ~ 2 = 7.351, P <0.05). The interval between diagnosis of liver failure and hemodialysis filtration in survivors was ( 2.58 ± 0.67) d, which was significantly shorter than that of the death group (6.07 ± 4.38) d (t = -4.167, P <0.05). The percentages of survivors with hepatic encephalopathy on admission were 83.3%, and the death rate was 96.6% (Χ ~ 2 = 0.672, P> 0.05). The survival rate of patients with stage II and III of acute kidney injury (AKI) was 8.3% and that of death group was 65.5%, with significant difference (χ ~ 2 = 8.711, P <0.05). MELD decreased (8.33 ± 4.19) points and increased PTA (21.72 ± 15.62)% on the 3rd day after the 3rd plasma membrane filtration in survivors compared with those before treatment The score increased (0.55 ± 6.66) points, PTA increased (6.38 ± 17.47)%, the difference between the two groups was statistically significant (t = 4.267, -2.633, all P <0.05). Conclusion Serum dialysis filtration therapy can improve the liver function and coagulation function in patients with advanced ACLF. The patients with pre-treatment cirrhosis, long course of liver failure and high AKI stage have a poor prognosis. After 72 h of treatment, the PTA and MELD score Patients with significantly improved prognosis.