富马酸替诺福韦二吡呋酯联合双重血浆分子吸附系统序贯血浆置换治疗慢加急性乙型肝炎肝衰竭患者疗效分析

doi:10.3969/j.issn.1672-5069.2020.05.021

摘要/Abstract

摘要： 目的分析富马酸替诺福韦二吡呋酯片(TDF)联合双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者的临床效果。方法 2016年9月～2019年9月收治的HBV-ACLF患者50例,其中25例观察组采用TDF联合DPMAS序贯PE治疗,另25例对照组采用TDF联合PE治疗。采用ELISA法检测血清白细胞介素-6(IL-6)。结果在治疗12周末,观察组血清胆红素水平为(24.0±14.5)μmol/L,国际标准化比值为(1.1±0.3),显著低于对照组【分别为(31.6±15.9)μmol/L和(1.3±0.4),P＜0.05】,而血清白蛋白水平为(34.8±6.1)g/L,显著高于对照组【(30.9±5.2)g/L,P＜0.05】;血清IL-6水平为(52.7±25.2)ng/L ,降钙素原为(0.4±0.1)ng/L,血小板/淋巴细胞比值为(120.6±24.4),和中性粒细胞/淋巴细胞比值为(1.9±0.5),显著低于对照组【分别为(67.2±30.8)ng/L、(0.5±0.2)ng/L 、(139.3±26.7)和(2.4±0.6),P＜0.05】;对照组生存12例(48.0%),观察组生存18例(72.0%,P＜0.05)。结论 TDF联合DPMAS序贯PE治疗HBV-ACLF患者近期疗效较好,可能与有效清除了血清内毒素,降低了细胞因子水平,改善了肝功能有关。

关键词: 肝衰竭, 乙型肝炎, 富马酸替诺福韦二吡呋酯, 血浆置换, 双重血浆分子吸附系统, 疗效 , ,

Abstract: Objective The aim of this study was to evaluate the efficacy of tenofovir disoproxil fumarate (TDF) and double plasma molecular absorb system (DPMAS) plus plasma exchange (PE) in treatment of patients with HBV-induced acute-on-chronic liver failure (HBV-ACLF). Methods 50 patients with HBV-ACLF HBV-ACLF were enrolled in this study and were divided into observation (n=25) and control group (n=25), receiving TDF, DPMAS and PE combination or TDF and DPMAS treatment. Serum interleukin-6 level was assayed by ELISA. Results At the end of 12 week treatment, serum bilirubin level in the observation group was (24.0 μmol/L, INR was(1.1±0.3), both significantly lower than 【(31.6±15.9)μmol/L and (1.3±0.4), respectively, P＜0.05】, while serum albumin level was (34.8±6.1)g/L, significantly higher than 【(30.9±5.2)g/L, P＜0.05】 in the control; serum IL-6 level was (52.7±25.2)ng/L, procalcitonin level was (0.4±0.1)ng/L, platelet-to-lymphocyte ratio was (120.6±24.4), and neutrophil-to-lymphocyte ratio was (1.9±0.5), all significantly lower than 【(67.2±30.8)ng/L, (0.5±0.2)ng/L, (139.3±26.7) and (2.4±0.6), respectively, P＜0.05】 in the control; the survival rate was significantly higher than that in the control group (72.0% vs. 48.0%,P＜0.05). Conclusion TDF combined with DPMAS and PE in treatment of patients with HBV-ACLF is efficacious, which might be related to the reduction of blood endotoxin and improve liver function recovery.

Key words: Acute-on-chronic liver failure, Hepatitis B, Tenofovir disoproxil fumarate, Plasma exchange, Double plasma molecular absorb system, Efficacy

董静, 刘龙梅, 陈照林, 陈曦, 宋海燕, 吕荣德, 张骏飞, 刘波. 富马酸替诺福韦二吡呋酯联合双重血浆分子吸附系统序贯血浆置换治疗慢加急性乙型肝炎肝衰竭患者疗效分析[J]. 实用肝脏病杂志, 2020, 23(5): 687-690.

Dong Jing,Liu Longmei,Chen Zhaolin,et al.. Efficacy of tenofovir disoproxil fumarate and double plasma molecular absorb system plus plasma exchange in treatment of patients with HBV-induced acute-on-chronic liver failure[J]. Journal of Practical Hepatology, 2020, 23(5): 687-690.

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