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目的观察人工肝支持系统(ALSS)-血浆置换(PE)治疗重型肝炎患者的疗效及其对外周血淋巴细胞亚群的影响。方法对34例重型肝炎进行PE治疗,血浆分离器采用EC-4A型,在患者治疗前后检测生化、凝血指标。同时即刻用流式细胞术(FCM)进行外周血淋巴细胞亚群检测。结果重型肝炎患者PE治疗后ALT、AST、TBil和DBil等生化指标较治疗前明显改善(P<0.01);血清白蛋白、总蛋白和胆固醇水平较治疗前明显提高(P<0.01);凝血酶原时间较治疗前明显缩短(P<0.01);治疗前后患者的白细胞、血小板、血红蛋白水平无明显改变(P>0.05)。治疗前后的外周血淋巴细胞亚群结果显示,重型肝炎患者血浆置换治疗后外周血CD3+细胞、CD3+CD4+细胞和CD3-CD19+细胞比率明显降低,CD3-CD56+细胞比率明显上升(P<0.05)。结论采用新型EC-4A型血浆分离器的PE治疗重型肝炎患者,可有效降低血液中的有害物质,明显改善肝功能和凝血功能,但对患者部分外周血淋巴细胞亚群的近期比值有影响。
Objective To observe the effect of artificial liver support system (ALSS) and plasma exchange (PE) on patients with severe hepatitis and its effect on peripheral blood lymphocyte subsets. Methods 34 cases of severe hepatitis were treated with PE, and the plasma separator was EC-4A. The biochemical and coagulation indexes were measured before and after treatment. At the same time, peripheral blood lymphocyte subsets were detected by flow cytometry (FCM) immediately. Results The biochemical indexes such as ALT, AST, TBil and DBil in patients with severe hepatitis were significantly improved after treatment (P <0.01), serum albumin, total protein and cholesterol were significantly higher than those before treatment (P <0.01) The original time was significantly shorter than before treatment (P <0.01); before and after treatment, the leukocyte, platelet and hemoglobin levels did not change significantly (P> 0.05). The results of peripheral blood lymphocyte subsets before and after treatment showed that the ratio of CD3 + cells, CD3 + CD4 + cells and CD3-CD19 + cells was significantly decreased and the ratio of CD3-CD56 + cells was significantly increased in patients with severe hepatitis after plasma exchange therapy (P <0.05). Conclusions PE treated with the new EC-4A plasma separator can effectively reduce the harmful substances in the blood and significantly improve the liver function and blood coagulation function. However, it has an impact on the recent ratio of some peripheral blood lymphocyte subsets in patients.