双重血浆分子吸附术对乙肝相关慢加急性肝衰竭患者细胞因子水平及预后的影响
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摘要
目的研究双重血浆分子吸附(DPMAS)模式治疗乙肝相关慢加急性早期肝衰竭患者细胞因子水平变化及临床价值。方法对80例乙肝相关慢加急性肝衰竭患者分别进行人工肝DPMAS(40例)和PE(40例)联合常规内科治疗,比较2组患者治疗前、治疗后的组内及组间总胆红素(TBIL)、总胆汁酸(TBA)、国际标准化比值(InR)及细肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)变化,观察不良反应及计算患者3个月的存活率。结果 2组患者组内比较,DPMAS组的TBIL、TBA、MELD评分及TNF-α、IL-6均降低,且差异有统计学意义(P<0.05),PE组的TBIL、InR、TBA、MELD评分、IL-6及TNF-α均降低,差异有统计学意义(P<0.05);2组患者治疗后组间比较,TBIL、InR、TBA、MELD评分、TNF-α、IL-6差异有统计学意义(P<0.05),3月后存活率DPMAS组(72.5%)优于PE组(65%);DPMAS组(10%)不良反应发生率低于PE组(17.5%)。结论 DPMAS模式治疗乙肝相关慢加急性早期肝衰竭在炎症细胞因子清除方面优于PE模式,且并发症低于PE模式,在临床早期肝衰竭患者人工肝模式的选择上可优先考虑。
Objective To investigate the changes of cytokine level and clinical value of double plasma molecular adsorption(DPMAS) model for the treatment of hepatitis B associated acute-on-chronic chronic liver failure. Methods 80 cases of hepatitis B associated acute-on-chronic chronic liver failure were treated with artificial liver DPMAS(40 cases) and PE(40 cases) in the combination with conventional medical treatment. The total bilirubin(TBIL), total bile acid(TBA), international standardization ratio(InR) and tumor necrosis factor alpha(TNF alpha), interleukin 6(IL-6) before and after treatment were compared between groups, so as to observe the adverse reactions and calculate the survival rate of patients for 3 months. Results TBIL, TBA, MELD scores, TNF-α and IL-6 in the DPMAS group all decreased, and the differences were statistically significant(P<0.05). TBIL, InR, TBA, MELD score, IL-6 and TNF-α in the PE group decreased, and the differences were all statistically significant(P<0.05). After treatment, the differences of TBIL, InR, TBA, MELD score, TNF-α, IL-6 between the groups were statistically significant(P<0.05), and the survival rate after 3 months was better than that of the PE group(72.5%); The incidence of adverse reactions in the DPMAS group(10%) was lower than that in the PE group(17.5%). Conclusion The inflammatory cytokine elimination of DPMAS group for treating hepatitis B associated acute-on-chronic chronic liver failure is better than PE group. Furthermore, the risk of complications is lower than the PE group. The treatment of artificial liver pattern in patients with early stage liver failure should be considered.
Objective To investigate the changes of cytokine level and clinical value of double plasma molecular adsorption(DPMAS) model for the treatment of hepatitis B associated acute-on-chronic chronic liver failure. Methods 80 cases of hepatitis B associated acute-on-chronic chronic liver failure were treated with artificial liver DPMAS(40 cases) and PE(40 cases) in the combination with conventional medical treatment. The total bilirubin(TBIL), total bile acid(TBA), international standardization ratio(InR) and tumor necrosis factor alpha(TNF alpha), interleukin 6(IL-6) before and after treatment were compared between groups, so as to observe the adverse reactions and calculate the survival rate of patients for 3 months. Results TBIL, TBA, MELD scores, TNF-α and IL-6 in the DPMAS group all decreased, and the differences were statistically significant(P<0.05). TBIL, InR, TBA, MELD score, IL-6 and TNF-α in the PE group decreased, and the differences were all statistically significant(P<0.05). After treatment, the differences of TBIL, InR, TBA, MELD score, TNF-α, IL-6 between the groups were statistically significant(P<0.05), and the survival rate after 3 months was better than that of the PE group(72.5%); The incidence of adverse reactions in the DPMAS group(10%) was lower than that in the PE group(17.5%). Conclusion The inflammatory cytokine elimination of DPMAS group for treating hepatitis B associated acute-on-chronic chronic liver failure is better than PE group. Furthermore, the risk of complications is lower than the PE group. The treatment of artificial liver pattern in patients with early stage liver failure should be considered.
引文
[1] 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,重型肝炎与人工肝学组.肝衰竭指南(2012年版)[J].中华肝脏病杂志,2013,21 (3):177-183.
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[4] 罗光成,黄云丽,闫惠平,等.HBV相关慢加急肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29 (1):26-30.
[5] 伍红艳,颜华东.全身炎症反应综合征对慢性乙型重型肝炎预后的影响研究[J].现代实用医学,2015,27(2):231-233.
[6] 郭永红,周云,张颖,等.慢加急性乙型肝炎肝衰竭患者Th1/Th2细胞的细胞因子变化及肝功能指标的关系[J].检验医学,2014,29 (3):274-278.
[7] 叶晓玲,程书权.非生物型人工肝及其联合应用的研究进展[J].中华临床医师杂志:电子版,2014,8(11):2150-2155.
[8] 胡铧东,刘寿荣.人工肝支持系统治疗肝衰竭的进展及其对细胞因子的影响[J].中国现代医生,2016,54(24):163-168.
[9] 高梦丹,赵艳.慢加急性肝衰竭息者预后相关免疫因素研究进展[J].临床肝胆病,2017,33(12):2462-2465.
[10] 黄建荣.人工肝在慢加急性肝衰竭中的应用现状及展望[J].中华肝病杂志,2016,24(12):935-939.
[11] 李兰娟.肝衰竭与李氏人工肝进展[J].中华临床感染病杂志,2017,10(2):92-94.
[12] 吴李贤,叶一农,何宏亮,等.血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效分析[J].热带医学杂志,2014,14(4):481-484.
[13] 温海洋,王存,李少洪,等.连续性静脉-静脉血液滤过对急性肝衰竭患者白介素-6-8及肿瘤坏死因子α的影响[J].河北医学,2013,19(8):1124-1127.
[14] 朱其荣,王川林,刘娇,等.分子吸附再循环系统对肝衰竭患者血清Th1/Th2型细胞因子水平的影响[J].实用肝脏病杂志,2017,20(1):107-108.
[15] 周建,黄建荣.不同血管通路进行人工肝治疗肝衰竭临床疗效及安全性研究[J].现代实用医学,2016,28(9):1148-1150.
[2] 李兰娟.人工肝脏[M].2版.杭州:浙江大学出版社传染病,2012:348-349.
[3] 叶一农,高志良.乙型肝炎肝衰竭发生机制中的三重打击[J].传染病信息,2009,22 (5):276-279.
[4] 罗光成,黄云丽,闫惠平,等.HBV相关慢加急肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29 (1):26-30.
[5] 伍红艳,颜华东.全身炎症反应综合征对慢性乙型重型肝炎预后的影响研究[J].现代实用医学,2015,27(2):231-233.
[6] 郭永红,周云,张颖,等.慢加急性乙型肝炎肝衰竭患者Th1/Th2细胞的细胞因子变化及肝功能指标的关系[J].检验医学,2014,29 (3):274-278.
[7] 叶晓玲,程书权.非生物型人工肝及其联合应用的研究进展[J].中华临床医师杂志:电子版,2014,8(11):2150-2155.
[8] 胡铧东,刘寿荣.人工肝支持系统治疗肝衰竭的进展及其对细胞因子的影响[J].中国现代医生,2016,54(24):163-168.
[9] 高梦丹,赵艳.慢加急性肝衰竭息者预后相关免疫因素研究进展[J].临床肝胆病,2017,33(12):2462-2465.
[10] 黄建荣.人工肝在慢加急性肝衰竭中的应用现状及展望[J].中华肝病杂志,2016,24(12):935-939.
[11] 李兰娟.肝衰竭与李氏人工肝进展[J].中华临床感染病杂志,2017,10(2):92-94.
[12] 吴李贤,叶一农,何宏亮,等.血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效分析[J].热带医学杂志,2014,14(4):481-484.
[13] 温海洋,王存,李少洪,等.连续性静脉-静脉血液滤过对急性肝衰竭患者白介素-6-8及肿瘤坏死因子α的影响[J].河北医学,2013,19(8):1124-1127.
[14] 朱其荣,王川林,刘娇,等.分子吸附再循环系统对肝衰竭患者血清Th1/Th2型细胞因子水平的影响[J].实用肝脏病杂志,2017,20(1):107-108.
[15] 周建,黄建荣.不同血管通路进行人工肝治疗肝衰竭临床疗效及安全性研究[J].现代实用医学,2016,28(9):1148-1150.