腹水浓缩回输联合抗感染治疗失代偿期乙型肝炎肝硬化患者疗效研究*

doi:10.3969/j.issn.1672-5069.2022.02.024

摘要/Abstract

摘要： 目的研究采用腹水浓缩回输联合抗感染治疗失代偿期乙型肝炎肝硬化患者的疗效。方法 2018年10月～2020年10月我院收治的失代偿期乙型肝炎肝硬化患者140例,采用随机数字表法将患者分为对照组70例和观察组70例,分别给予头孢哌酮钠/舒巴坦钠静脉滴注治疗或在此基础上给予腹水浓缩回输治疗,两组均治疗观察2 w。采用放射免疫法检测血清内皮素-1(ET-1)、血浆肾素活性(PRA),采用化学发光法检测血清血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD),采用ELISA法检测血清白细胞介素-6(IL-6)、IL-8和IL-10,采用显色法检测血清内毒素(LPS),采用硝酸盐还原酶法检测血清一氧化氮(NO)。结果在治疗2 w末,观察组总有效率为95.7%,显著高于对照组的82.9%(P＜0.05);观察组血清BUN和sCr水平分别为(5.7±1.6)mmol/L和(115.1±27.7)μmol/L,显著低于对照组【分别为(7.1±2.1)mmol/L和(132.6±31.3)μmol/L,P＜0.05】;观察组血清PRA、AngⅡ和ALD水平分别为(2.9±0.9)ng/mL/h、(290.5±64.3)ng/L和(258.1±74.2)pg/mL,显著低于对照组【分别为(3.8±1.0)ng/mL/h、(320.9±75.4)ng/L和(276.5±68.4)pg/mL,P＜0.05】;观察组血清LPS和ET-1分别为(0.07±0.01)EU/mL和(75.5±2.6)ng/L,显著低于对照组【分别为(0.10±0.03)EU/mL和(89.6±5.2)ng/L,P＜0.05】,而血清NO水平为(69.4±4.3)μmol/L,显著高于对照组【(55.7±3.6)μmol/L,P＜0.05】。结论采取腹水浓缩回输联合抗感染治疗失代偿期乙型肝炎肝硬化患者,可消退腹水,改善肾功能,可能与抑制了肾素-血管紧张素-醛固酮系统的激活,降低了血清缩血管物质有关。

关键词: 肝硬化, 腹水浓缩回输, 头孢哌酮钠/舒巴坦钠, 肾素-血管紧张素-醛固酮系统, 治疗

Abstract: Objective This study aimed to investigate the cell-free and concentrated ascites reinfusion therapy (CFCART) for treatment of patients withdecompensated liver cirrhosis (DLC). Methods 140 patients with hepatitis B-induced DLC were enrolled in our hospitalbetween October 2018 and October 2020, and they were randomly divided into control and observation group, with 70 cases in each group. The patients in the control group wasintravenously given cefoperazone sodium and sulbactam sodium, and those in the observation group received CFCART therapy.The regimen lasted for two weeks. Serum urea nitrogen (BUN), creatinine (sCr), plasma renin activity (PRA) , endothelin-1(ET-1) and angiotensinogen II (Ang II),aldosterone (ALD), interleukin-6 (IL-6), IL-8 and IL-10, endotoxin (LPS) and nitric oxide (NO) levels were assayed. Results At the end of two week treatment, the total efficient rate in the observation group was 95.7%, significantly higher than 82.9%(P＜0.05) in the control; serumBUN and sCr levels in the observation were (5.7±1.6)mmol/L and (115.1±27.7)μmol/L, significantly lower than [(7.1±2.1)mmol/L and (132.6±31.3)μmol/L, P＜0.05] in the control; serum PRA, AngⅡ and ALD levels were (2.9±0.9)ng/mL/h, (290.5±64.3)ng/L and (258.1±74.2)pg/mL, all significantly lower than [(3.8±1.0)ng/mL/h, (320.9±75.4)ng/L and (276.5±68.4)pg/mL, respectively, P＜0.05] in the control; serum LPS and ET-1 levels were(0.07±0.01)EU/mL and (75.5±2.6)ng/L, significantly lower than [(0.10±0.03)EU/mL and (89.6±5.2)ng/L, P＜0.05], while serum NO level was(69.4±4.3)μmol/L, significantly higher than [(55.7±3.6)μmol/L, P＜0.05] in the control group. Conclusion The CFCART therapy in dealing with patients with DLC could effectively improve kidney functions, which might be related to the inhibition of renin angiotensin aldosterone system.

Key words: Liver cirrhosis, Ascites concentration and reinfusion, Cefoperazone/sulbactam, Renin angiotensin aldosterone system, Therapy

王本贤, 李伟, 李东生, 李华. 腹水浓缩回输联合抗感染治疗失代偿期乙型肝炎肝硬化患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(2): 247-250.

Wang Benxian, Li Wei, Li Dongsheng, et al. Cell-free and concentrated ascites reinfusion therapy for patients with decompensated cirrhosis[J]. Journal of Practical Hepatology, 2022, 25(2): 247-250.

参考文献

[1] Spyrou E, Smith CI, Ghany MG. Hepatitis B: Current status of therapy and future therapies. Gastroenterol Clin North Am, 2020, 49(2):215-238.
[2] Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for liver cirrhosis: ascites and related complications. Clin Mol Hepatol, 2018, 24(3):230-277.
[3] Wang W, Liu Y, Yu C, et al. Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study. Expert Opin Drug Saf, 2020, 19(3):339-347.
[4] 贺连栋, 曹淑琴, 韩灿,等. 腹水浓缩回输治疗失代偿期肝硬化患者肾血流和血清血管活性因子水平的变化. 实用肝脏病杂志, 2020, 23(5):707-710.
[5] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2019年版).实用肝脏病杂志,2020,23(1)S9-32.
[6] European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol, 2012, 57(2):399-420.
[7] Runyon BA, AASLD. Introduction to the revised American association for the study of liver diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4):1651-1653.
[8] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南. 实用肝脏病杂志, 2018, 21(1) :21-31.
[9] Neong SF, Adebayo D, Wong F. An update on the pathogenesis and clinical management of cirrhosis with refractory ascites. Expert Rev Gastroenterol Hepatol, 2019, 13(4):293-305.
[10] 许飞, 姜曼蕾, 胡江玲,等. 肝硬化并发腹腔感染病原菌与营养状况及免疫功能. 中华医院感染学杂志, 2020, 30(21):98-102.
[11] Dong Y, Li Y, Zhang Y, et al. Cefoperazone/sulbactam therapeutic drug monitoring in patients with liver cirrhosis: potential factors affecting the pharmacokinetic/pharmacodynamic target attainment. Basic Clin Pharmacol Toxicol, 2019, 125(4):353-359.
[12] Singh SK, Poddar U, Mishra R, et al. Ascitic fluid infection in children with liver disease: time to change empirical antibiotic policy. Hepatol Int, 2020, 14(1):138-144.
[13] Iwasa M, Ishihara T, Kato M, et al. Cell-free and concentrated ascites reinfusion therapy for refractory ascites in cirrhosis in post-marketing surveillance and the role of tolvaptan. Intern Med, 2019, 58(21):3069-3075.
[14] Shimizu S, Ohira M, Nakano R, et al. Management of refractory ascites for liver transplant candidates: a novel cell-free and concentrated ascites reinfusion therapy. Transplant Proc, 2019, 51(8):2740-2744.
[15] Nakamura H, Hanafusa N, Kitamura K, et al. Biochemical evaluation of processed ascites in patients undergoing cell-free and concentrated ascites reinfusion therapy. Ther Apher Dial, 2020, 24(5):516-523.
[16] 赵先胜, 翁伦华, 程寄吾,等. 腹水浓缩结合抗菌药物对肝硬化并发腹水感染患者实验室指标影响的研究. 中华医院感染学杂志, 2019, 29(1):75-77.
[17] Ito T, Hanafusa N, Iwase S, et al. Ascitic IL-10 concentration predicts prognosis of patients undergoing cell-free and concentrated ascites reinfusion therapy. Ther Apher Dial, 2020, 24(1):90-95.
[18] Adebayo D, Neong SF, Wong F. Refractory ascites in liver cirrhosis. Am J Gastroenterol, 2019, 114(1):40-47.
[19] Crismale JF, Friedman SL. Acute liver injury and decompensated cirrhosis. Med Clin North Am, 2020, 104(4):647-662.
[20] Zhao R, Lu J, Shi Y, et al. Current management of refractory ascites in patients with cirrhosis. J Int Med Res, 2018, 46(3):1138-1145.

腹水浓缩回输联合抗感染治疗失代偿期乙型肝炎肝硬化患者疗效研究^*

Cell-free and concentrated ascites reinfusion therapy for patients with decompensated cirrhosis

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