血浆置换联合血液滤过治疗慢加急性乙型肝炎肝衰竭患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.03.019

摘要/Abstract

摘要： 目的观察比较发病不同时间启动血浆置换(PE)联合血液滤过(HF)治疗慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者的疗效。方法 2021年3月～2024年3月我院收治的126例HBV-ACLF患者,使用日本山阳电子工业生产的KM-9000型血液净化装置进行PE治疗,使用日本山阳电子工业生产的KM-9000型血液净化装置进行HF治疗,其中37例对照组在入院72 h后,而89例观察组在入院72 h内启动人工肝治疗。结果观察组人工肝治疗(3.4±1.4)次,显著少于对照组【(4.6±1.1)次,P<0.05】,而观察组28 d和90 d生存率分别为84.2%和67.4%,显著高于对照组的67.6%和48.6%(P<0.05);在治疗3个月末,对照组和观察组血清HBV DNA转阴率均为100.0%(P>0.05);在人工肝治疗前后,两组血钾、血钠和血氯水平差异无统计学意义(P>0.05);在经过平均3个月,60例观察组生存者血清TBIL、凝血酶原活动度(PTA)和血清白蛋白水平分别为(25.8±7.6)μmol/L、(68.2±9.3)%和(34.7±2.8)g/L,与18例对照组生存者比,无显著性差异【分别为(28.4±5.9)μmol/L、(63.7±8.6)%和(35.6±2.5)g/L,P<0.05】。结论对于明确诊断的肝衰竭患者,在入院后尽早启动人工肝治疗可能能提高救治成功率,任何的观望和拖延都可能不利于改善预后。

关键词: 慢加急性肝衰竭, 血浆置换, 血液滤过, 治疗

Abstract: Objective The aim of this study was to compare the efficacy of plasma exchange (PE) and hemofiltration (HF) at different start-up time in the treatment of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods 126 patients with HBV-ACLF were enrolled in our hospital between March 2021 and March 2024, and all patients underwent PE/HF therapy. Artificial liver supporting system (ALSS) treatment started early (less than 72 hours after admission) in 89 cases (observation), and started lately (72 hours thereafter) in 37 cases (control). Results ALSS carried out repeatedly for (3.4±1.4)times in the observation group, much less than [(4.6±1.1)times, P<0.05] in the control, while 28-day and 90 day survivals were 84.2% and 67.4%, much higher than 67.6% and 48.6%(P<0.05) in the control; by three months after treatment, serum HBV DNA went to negative in all the patients in the two groups; there were no significant differences as respect to serum potassium, sodium and chlorine levels before and after ALSS treatment in the two groups(P>0.05); after treatment, total serum bilirubin level, prothrombin time activity and serum albumin level in 60 survivals in the observation group were (25.8±7.6)μmol/L, (68.2±9.3)% and (34.7±2.8)g/L, not significantly different as compared to [(28.4±5.9)μmol/L, (63.7±8.6)% and (35.6±2.5)g/L, respectively, P<0.05] in 18 survivals in the control group. Conclusion ALSS treatment should start as early as possible after admission in patients with ACLF, and any delay and hesitancy might decrease successful rescue rate.

Key words: Acute-on-chronic liver failure;Plasma exchange, hemofiltration, Therapy

李勇飞, 许正锯, 叶巧霞, 威晋. 血浆置换联合血液滤过治疗慢加急性乙型肝炎肝衰竭患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 394-397.

Li Yongfei, Xu Zhengju, Ye Qiaoxia, et al. Efficacy of plasma exchange and hemofiltration in the treatment of patients with acute-on-chronic hepatitis B liver failure[J]. Journal of Practical Hepatology, 2025, 28(3): 394-397.

参考文献

[1] Bhatti TK, Singal AK, Kwo PY. Viral hepatitis and acute-on-chronic liver failure. Clin Liver Dis, 2023, 27(3):617-630.
[2] 徐曼曼,李珊珊,杨颜榕,等.2012至2021年北京佑安医院肝衰竭住院患者流行病学特征.中华肝脏病杂志,2024,32(1):49-57.
[3] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会感染病学分会肝衰竭与人工肝专家委员会,国家感染性疾病临床医学研究中心,等.人工肝血液净化系统治疗指南(2023年版).中华临床感染病杂志,2023,16(6):401-411.
[4] 中华医学会肝病学分会重型肝病与人工肝学组,白浪,陈煜,等.人工肝血液净化技术临床应用专家共识(2022年版).实用肝脏病杂志,2022,25(3):457-468.
[5] Beran A, Mohamed MFH, Shaear M, et al. Plasma exchange foracute and acute-on-chronic liver failure: A systematic review and meta-analysis. Liver Transpl, 2024, 30(2):127-141.
[6] 马万龙,马玉,王伟红,等.慢加急性肝衰竭患者预后生存分析.中华肝脏病杂志,2023,31(10):1051-1055.
[7] Ocak I. A 15-year retrospective study of supportive extracorporeal therapies including plasma exchange and continuous venovenous hemodiafiltration of 114 adults with acute liver failure awaiting liver transplantation. Ann Transplant, 2023, 28:e939745.
[8] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版).实用肝脏病杂志,2019,22(2):164-171.
[9] Wang XH, Peng BB, Zhang L, et al. Mixed mode of artificial liver support in patients with acute-on-chronic liver failure: a retrospective cohort study. Hepatol Int, 2023, 17(5):1241-1250.
[10] Goel A, Zachariah U, Daniel D, et al. Growing evidence for survival benefit with plasma exchange to treat liver failure. J Clin Exp Hepatol, 2023, 13(6):1061-1073.
[11] Zachariah U, Vijayalekshmi B, Matthai SM, et al. Extra-corporeal non-liver transplant therapies for acute liver failure: Focus on plasma exchange and continuous renal replacement therapy. Indian J Gastroenterol, 2024, 43(2):338-348.
[12] 安薪宇,胡灵溪,李妹,等.非生物型人工肝治疗前后细胞因子水平变化对慢加急性肝衰竭治疗时机选择及其短期疗效的预测.中华肝脏病杂志,2022,30(11):1218-1224.
[13] Dandu H, Kumar V, Goel A, et al. A preliminary experience of plasma exchange in liver failure. Asian J Transfus Sci, 2022, 16(2):209-213.
[14] 中华医学会感染病学分会肝衰竭与人工肝学组,传染病重症诊治全国重点实验室,国家传染病医学中心.人工肝血液净化系统治疗细胞因子风暴综合征专家共识.中华临床感染病杂志,2024,17(1):14-22.
[15] Yuan HX, Su JR, Zhang QY, et al. Characterization of theclinical features in HBV-related acute-on-chronic liver failure. Altern Ther Health Med, 2022, 28(2):65-69.
[16] Praharaj DL, Anand AC. Clinical implications, evaluation, and management of hyponatremia in cirrhosis. J Clin Exp Hepatol, 2022, 12(2):575-594.
[17] Li X, Li H, Zhu Y, et al. PLT counts as a predictive marker after plasma exchange in patients with hepatitis B virus-related acute-on-chronic liver failure. J Clin Med,2023,12(3):851.
[18] Zanetto A, Pelizzaro F, Campello E, et al. Severity of systemic inflammation is the main predictor of ACLF and bleeding in individuals with acutely decompensated cirrhosis. J Hepatol, 2023, 78(2):301-311.
[19] 李红,卫飞燕,邓春青,等.小剂量阿加曲班补救治疗人工肝治疗中出现的肝素介导性血小板减少症1例.中华肝脏病杂志,2021,29(12):1198-1200.
[20] Ye QX, Huang JF, Xu ZJ, et al. Short-term prognostic factors for hepatitis B virus-related acute-on-chronic liver failure. World J Clin Cases, 2022, 10(23):8186-8195.

血浆置换联合血液滤过治疗慢加急性乙型肝炎肝衰竭患者疗效研究^*

Efficacy of plasma exchange and hemofiltration in the treatment of patients with acute-on-chronic hepatitis B liver failure

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	罗悦心, 罗红春. 白介素-2治疗自身免疫性肝炎疗效研究进展与展望^*[J]. 实用肝脏病杂志, 2025, 28(3): 330-333.
[2]	孔丽霞, 陈旭峰, 许艳, 周建飞, 孙舒. 恩替卡韦经治慢性乙型肝炎低病毒血症患者联合或序贯艾米替诺福韦治疗疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 334-337.
[3]	王浩, 王清园, 沈琼, 许宇文. 聚乙二醇化干扰素α-2a联合艾尔巴韦/格拉瑞韦治疗慢性丙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 346-349.
[4]	徐玲玲, 卢远, 郑燕钗, 杨本场. 二甲双胍联合双环醇治疗非酒精性脂肪性肝炎患者短期疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 358-361.
[5]	温大超, 张秋萍, 石凌. 穴位贴敷联合运动处方治疗非酒精性脂肪性肝病患者疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 370-373.
[6]	马丹彤, 杨爽, 高丽丽, 高学松, 段雪飞. 伴有自身免疫现象的药物性肝损伤患者临床特征分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 390-393.
[7]	许荣波, 王艳, 王晓松, 王晓燕. 内镜曲张静脉套扎术联合生长抑素和艾司奥美拉唑治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 410-413.
[8]	蒋召芹, 宋洁, 穆永芳. 内镜曲张静脉套扎术联合生长抑素和奥美拉唑治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 422-425.
[9]	杨懿瑾, 洪晗, 陈彬, 崔洪全, 王逸, 张甲. FOLFOX肝动脉灌注化疗联合仑伐替尼和PD-1抑制剂治疗中晚期原发性肝癌患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 426-429.
[10]	刘松涛, 李娟, 刘梅, 刘晖, 闾军. 15例肝细胞癌发生消化道穿孔患者临床特征分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 430-433.
[11]	李宏建, 许织文, 夏斐, 盛建国. 超声引导穿刺引流治疗细菌性肝脓肿患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 454-457.
[12]	晏化军, 陈兴云, 马兵, 杨冲. UG-PTGD联合LC术治疗急性结石梗阻性胆囊炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 458-461.
[13]	冯淞, 李连杰, 程波. PTGD序贯保留胆囊动脉主干的LC术治疗急性胆囊炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 462-465.
[14]	柯俊杰, 邢杰宇, 张明英. 内镜逆行胰胆管造影术与腹腔镜胆总管切开探查术治疗胆囊切除术后胆总管结石患者效果比较^*[J]. 实用肝脏病杂志, 2025, 28(3): 466-469.
[15]	吕天富, 南琼. 经颈静脉肝内门体分流术治疗肝硬化门静脉高压症患者抗凝治疗研究进展[J]. 实用肝脏病杂志, 2025, 28(2): 165-168.