无肝素化连续性肾脏替代治疗肝硬化并发肝性脑病患者疗效研究*

doi:10.3969/j.issn.1672-5069.2021.06.027

摘要/Abstract

摘要： 目的探讨无肝素化连续性肾脏替代疗法(CRRT)治疗肝硬化并肝性脑病(HE)患者的疗效以及血氨和细胞因子水平的变化。方法 2018年1月～2021年1月我院诊治的62例肝硬化并发HE患者,其中接受常规护肝和抗肝昏迷治疗31例(对照组),在此基础上接受无肝素化CRRT治疗31例(观察组)。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和IL-10水平,采用谷氨酸脱氢酶法检测血氨水平。结果观察组患者神志转清时间为(3.1±1.0)d,住院时间为(8.1±1.3)d,显著短于对照组【分别为(4.8±1.1)d和(12.5±1.5)d,P<0.01】,观察组患者病死率为6.5%,显著低于对照组的25.8%(P<0.05);治疗后,观察组血氨、TNF-α和IL-6水平分别为(69.3±10.5)mmol/L、(7.1±1.7)ng/L和(9.5±2.0)ng/L,显著低于对照组[分别为(94.8±8.1)mmol/L、(9.4±1.9)ng/L和(12.4±2.5)ng/L,P<0.01],而两组血清IL-10水平[(8.1±1.4)ng/L对(7.3±1.6)ng/L,P>0.01]比较,无显著性差异;观察组血清总胆红素水平为(41.2±8.6)μmol/L,显著低于对照组[(50.4±9.7)μmol/L,P<0.05],而两组血清白蛋白[(32.9±3.2)g/L对(32.4±2.8)g/L]和INR [(1.2±0.4)对(1.3±0.4)]相比,无显著性差异(P>0.05)。结论采用无肝素化CRRT治疗肝硬化并发HE患者效果显著,可有效降低血氨和细胞因子水平,提高生存率,值得进一步观察。

关键词: 肝性脑病, 肝硬化, 连续性肾脏替代疗法, 血氨, 细胞因子, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of continuous renal replacement therapy (CRRT) without heparinization in patients with liver cirrhosis complicated by hepatic encephalopathy (HE), and its influence on blood ammonia and cytokine levels. Methods 62 patients with liver cirrhosis complicated by HE were enrolled in our hospital between January 2018 and January 2021. Among them, 31 patients received conventional liver protection and anti-hepatic coma treatment (control group), and on this basis, another 31 patients were treated with CRRT without heparinization (observation group). Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10 levels were detected by enzyme-linked immunosorbent assay. Serum total bilirubin (TBIL), albumin (ALB) and ammonia levels were detected by fully automatic biochemical analyzer. Results The consciousness recovery time and hospital stay were(3.1±1.0)d and (8.1±1.3)d, both significantly shorter than [(4.8±1.1)d and (12.5±1.5)d, respectively, P<0.01] in the control, and the fatal rate was 6.5%, significantly lower than 25.8%(P<0.05) in the control; after treatment, serum ammonia, TNF-α and IL-6 levels were (69.3±10.5)mmol/L, (7.1±1.7)ng/L and (9.5±2.0)ng/L, all significantly lower than [(94.8±8.1)mmol/L, (9.4±1.9)ng/L and (12.4±2.5)ng/L, respectively, P<0.01] in the control, while there was no significant difference respect to serum IL-10 levels [(8.1±1.4)ng/L vs. (7.3±1.6)ng/L, P>0.01] in the two group ; total serum bilirubin level in the observation group was (41.2±8.6)μmol/L, significantly lower than [(50.4±9.7)μmol/L, P<0.05] in the control, while there were no significant differences respect to serum albumin levels [(32.9±3.2)g/L vs.(32.4±2.8)g/L] or INR [(1.2±0.4) vs. (1.3±0.4)] in the two groups (P>0.05). Conclusion The application of CRRT without heparinization is significantly efficacious in dealing with patients with liver cirrhosis and HE, and it could effectively reduce blood ammonia and cytokine levels and improve survival.

Key words: Hepatic encephalopathy, Liver cirrhosis, Continuous renal replacement therapy, Blood ammonia, Cytokines, Therapy

黄力鸥, 吴春荣, 徐丹, 崔宇慧, 唐建国. 无肝素化连续性肾脏替代治疗肝硬化并发肝性脑病患者疗效研究^*[J]. 实用肝脏病杂志, 2021, 24(6): 875-878.

Huang Liou, Wu Chunrong, Xu Dan, et al. Efficacy of continuous renal replacement therapy without heparinization in patients with liver cirrhosis complicated by hepatic encephalopathy[J]. Journal of Practical Hepatology, 2021, 24(6): 875-878.

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无肝素化连续性肾脏替代治疗肝硬化并发肝性脑病患者疗效研究^*

Efficacy of continuous renal replacement therapy without heparinization in patients with liver cirrhosis complicated by hepatic encephalopathy

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