CRRT联合PE治疗慢加急性乙型肝炎肝衰竭并发急性肾损伤患者疗效研究*

doi:10.3969/j.issn.1672-5069.2020.06.019

Abstract

Abstract: Objective The purpose of this study was to investigate the efficacy of continuous renal replacement therapy (CRRT) and plasma exchange (PE) combination in the treatment of patients with acute-on-chronic hepatitis B liver failure (ACLF) complicated by acute kidney injury (AKI). Methods 65 ACLF patients caused by hepatitis B viral infection and AKI were treated in ICU of our hospital between October 2016 and November 2019, and 35 cases received CRRT and PE combination and 30 received PE alone at base of conventional supporting management. The estimated glomerular filtration rate (eGFR), creatinine clearance rate (Ccr) and model for end-stage liver disease-Na (MELD-Na) were calculated. Results The survival rate in combination-treated group at day 90 was 54.3%, significantly higher than 23.3% in the PE-treated group (P<0.05); at the end of 90 day treatment, serum bilirubin level in 19 survivals in CRRT and PE-treated group was (28.8±11.1) μmol/L, much lower than 【(39.4±13.0) μmol/L, P<0.05】 in 7 patients in PE-treated group; at the end of day 28, the eGFR in 25 survivals in CRRT and PE combination-treated group was (79.4±24.7) mL/min/1.73 m², significantly higher than (65.75±16.1)mL/min/1.73 m², P<0.05】, the Ccr was (77.3±25.7)mL/min, much higher than 【(63.4±20.1)mL/min, P<0.05】, and the MELD-Na score was (22.4±4.5), significantly lower than 【(29.5±4.1)%, P<0.05】 in 16 survivals in PE-treated group, while the three parameters above mentioned in the survivals of the two groups at day 90 were not significantly different (P>0.05). Conclusion The application of CRRT and PE in the treatment of patients with ACLF caused byhepatitis B viral infection and complicated by AKI could reduce the short-term mortality, which might protect the liver and kidney functions and warrants further multi-central clinical trials.

Key words: Acute-on-chronic liver failure, Hepatitis B, Acute kidney injury, Continuous renal replacement therapy, Plasma exchange, Therapy

Guan Wantao, Kang Fuxin, Lin Wei, et al. Decreased 90-day mortality in patients with hepatitis B-induced acute-on-chronic liver failure and acute kidney injury by continuous renal replacement therapy and plasma exchange treatment[J]. Journal of Practical Hepatology, 2020, 23(6): 833-836.

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Decreased 90-day mortality in patients with hepatitis B-induced acute-on-chronic liver failure and acute kidney injury by continuous renal replacement therapy and plasma exchange treatment

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