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目的探讨血浆置换(PE)联合血浆吸附(PA)与单纯PE治疗慢性重型肝炎的效果。方法 97例慢性重型肝炎患者,随机分为治疗组(51例)与对照组(46例),治疗组在普通保肝、对症治疗基础上给予PE+PA联合治疗,对照组在保肝、对症治疗基础上给予单纯PE治疗,观察两组治疗前后的症状、体征、化验指标、治疗效果及不良反应情况。结果两组患者经治疗后大部分精神、食欲好转,乏力、腹胀等症状及皮肤黏膜黄染明显减轻;治疗组及对照组治疗后总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总蛋白(TP)、白蛋白(ALB)、胆碱酯酶(CHE)、血氨(NH_3)、凝血酶原活动度(PTA)、内毒素(LPS)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素Ⅱ受体(s IL-2R)较治疗前均有明显好转(P<0.01或P<0.05),且治疗后治疗组TBIL、ALT、AST、NH_3、PTA、LPS、TNF-α、IL-6、s IL-2R优于对照组(P<0.01或P<0.05)。追踪观察12周,治疗组好转率高于对照组(P<0.05)。结论 PE+PA治疗慢性重型肝炎能显著改善肝功能,提高存活率。
Objective To investigate the effect of plasma exchange (PE) combined with plasma adsorption (PA) and simple PE in the treatment of chronic severe hepatitis. Methods Ninety-seven patients with chronic severe hepatitis were randomly divided into treatment group (n = 51) and control group (n = 46). The treatment group received PE plus PA combination therapy on the basis of common liver protection and symptomatic treatment. Treatment based on simple PE treatment, observation of the two groups before and after treatment of the symptoms, signs, laboratory indicators, treatment and adverse reactions. Results After treatment, most of the patients were relieved of symptoms such as improvement of appetite, weakness, bloating and other symptoms, and yellowing of skin and mucosa. After treatment, the levels of total bilirubin (TBIL), alanine aminotransferase (ALT) AST, TP, ALB, CHE, NH3, PTA, LPS, Tumor Necrosis Factor - TNF-α, IL-6 and sIL-2R were significantly improved (P <0.01 or P <0.05) before treatment, and after treatment The levels of TBIL, ALT, AST, NH_3, PTA, LPS, TNF-α, IL-6 and sIL-2R in control group were better than those in control group (P <0.01 or P <0.05). Tracing the observation for 12 weeks, the improvement rate of the treatment group was higher than that of the control group (P <0.05). Conclusion PE + PA treatment of chronic severe hepatitis can significantly improve liver function and improve survival rate.