免疫治疗对重型肝炎与肝炎后肝硬化合并感染的临床疗效观察
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摘要
目的探讨免疫治疗对重型肝炎与肝炎后肝硬化合并感染的临床疗效。方法将2016年4月～2018年4月在我院消化内科治疗的84例重型肝炎与肝炎后肝硬化合并感染患者随机分为两组,对照组采用常规保肝、抗感染及对症支持治疗,在此基础上观察组使用免疫制剂治疗,比较两组患者的感染控制效果、炎性因子水平变化、肝功能各指标变化、疾病转归。结果观察组感染控制率为88.10%,明显高于对照组的61.90%(P<0.05);观察组治疗后CRP、WBC、PCT、TNF-α水平均明显低于对照组(P<0.05);观察组治疗后总胆红素、丙氨酸氨基转移酶、白蛋白、凝血酶原时间、总胆固醇与对照组相比无明显差异(P>0.05),但两组治疗后较治疗前各指标明显下降(P<0.05);观察组上消化道出血、肝肾综合征、肝性脑病、死亡等发生率均明显低于对照组(P<0.05)。结论重型肝炎与肝炎后肝硬化合并感染在常规抗感染、保肝等治疗基础上使用免疫制剂,可有效提升疗效,促进炎症消退,保护肝功能,降低并发症发生率及死亡率。
Objective To investigate the clinical efficacy of immunotherapy for severe hepatitis and post-hepatitic cirrhosis with infection. Methods 84 patients with severe hepatitis and post-hepatitis cirrhosis who were treated in the department of gastroenterology of our hospital from April 2016 to April 2018 were randomly divided into two groups.The control group received routine liver protection, anti-infection and symptomatic supportive treatment. On this basis,the observation group was treated with immunological agents. The infection control effect, the change of inflammatory factors, the change of liver function indexes, and the disease outcome were compared between the two groups. Results The infection control rate of the observation group was 88.10%, which was significantly higher than that of the control group(61.90%). The levels of CRP, WBC, PCT and TNF-α in the observation group were significantly lower than those in the control group(P<0.05). There was no significant difference in total bilirubin, alanine aminotransferase, albumin,prothrombin time and total cholesterol between the observation group and the control group(P>0.05). But the indexes of the two groups after treatment were decreased significantly(P<0.05). The incidence of upper gastrointestinal hemorrhage,hepatorenal syndrome, hepatic encephalopathy and death in the observation group were significantly lower than those in the control group(P<0.05). Conclusion The use of immunological preparations on the basis of conventional anti-infective, liver-protecting and other treatments for severe hepatitis and post-hepatitis cirrhosis can effectively improve the efficacy, promote inflammation, protect liver function, and reduce the incidence of complications and mortality.
Objective To investigate the clinical efficacy of immunotherapy for severe hepatitis and post-hepatitic cirrhosis with infection. Methods 84 patients with severe hepatitis and post-hepatitis cirrhosis who were treated in the department of gastroenterology of our hospital from April 2016 to April 2018 were randomly divided into two groups.The control group received routine liver protection, anti-infection and symptomatic supportive treatment. On this basis,the observation group was treated with immunological agents. The infection control effect, the change of inflammatory factors, the change of liver function indexes, and the disease outcome were compared between the two groups. Results The infection control rate of the observation group was 88.10%, which was significantly higher than that of the control group(61.90%). The levels of CRP, WBC, PCT and TNF-α in the observation group were significantly lower than those in the control group(P<0.05). There was no significant difference in total bilirubin, alanine aminotransferase, albumin,prothrombin time and total cholesterol between the observation group and the control group(P>0.05). But the indexes of the two groups after treatment were decreased significantly(P<0.05). The incidence of upper gastrointestinal hemorrhage,hepatorenal syndrome, hepatic encephalopathy and death in the observation group were significantly lower than those in the control group(P<0.05). Conclusion The use of immunological preparations on the basis of conventional anti-infective, liver-protecting and other treatments for severe hepatitis and post-hepatitis cirrhosis can effectively improve the efficacy, promote inflammation, protect liver function, and reduce the incidence of complications and mortality.
引文
[1]王明芳,林苏,朱月永,等.常用炎性反应指标在肝硬化合并感染性发热患者的早期诊断价值及成本效益分析[J].中华传染病杂志,2016,34(6):327-331.
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[9]郑宇,张雪青,吴金明,等.肝硬化合并细菌感染患者血清降钙素原和C-反应蛋白水平的研究[J].中华消化杂志,2006,26(10):701-702.
[10]彭浩.胸腺肽α1联合抗生素治疗肝硬化合并自发性细菌性腹膜炎的疗效观察[J].中国医师进修杂志,2012,35(1):53-54.
[11]陈凯红,蒲云川,尹翠兰,等.氟康唑治疗重型肝炎和肝硬化合并真菌感染的疗效观察[J].肝脏,2013,18(9):653-654.
[12]徐淑凡,朱银芳,华忠,等.胸腺肽α1联合苦参素治疗丙型肝炎后肝硬化代偿期的临床观察[J].中外妇儿健康,2011,(8):293-294.
[13]周智宏,张国顺,刘培光,等.低剂量短效干扰素联合胸腺肽α1治疗失代偿期丙型肝炎肝硬化临床效果观察[J]中国综合临床,2012,28(8):861-863.
[14]孙颖,赵旭.白蛋白水平对除自发性腹膜炎外的肝硬化合并感染者的影响[J].临床肝胆病杂志,2015,(1):57.
[15]余永勤,刘汉勤,陈谭昇,等.人免疫球蛋白治疗肝硬化合并感染105例[J].世界华人消化杂志,2013,21(23):2344-2348.
[2]张克强.重型肝炎与肝炎后肝硬化合并感染的临床研究[J].中华医院感染学杂志,2013,23(9):2062-2063.
[3]危北海,张万岱,陈治水,等.肝硬化中西医结合诊治方案(草案)[J].中国中西医结合杂志,2004,24(10):869-871.
[4]龚环宇,刘振国,张浩晔,等.重型肝炎及肝硬化继发感染病原菌分布与抗菌药物使用分析[J].中华医院感染学杂志,2010,20(16):2483-2486.
[5]夏玲玲,程君,吴玲,等.重型肝炎和肝硬化并发肺炎95例临床分析[J].安徽医学,2011,32(10):1678-1680.
[6]南月敏,牛学敏.肝硬化合并感染的早期识别与经验性治疗[J].临床肝胆病杂志,2015,31(3):349-353.
[7]陈衍秋.免疫治疗对72例肝硬化合并感染患者的临床效果[J].中华全科医学,2017,15(3):449-451.
[8]施杨利,陈耀明.白蛋白对老年肝硬化合并感染患者血容量及预后的影响[J].现代中西医结合杂志,2017,26(30):3346-3347.
[9]郑宇,张雪青,吴金明,等.肝硬化合并细菌感染患者血清降钙素原和C-反应蛋白水平的研究[J].中华消化杂志,2006,26(10):701-702.
[10]彭浩.胸腺肽α1联合抗生素治疗肝硬化合并自发性细菌性腹膜炎的疗效观察[J].中国医师进修杂志,2012,35(1):53-54.
[11]陈凯红,蒲云川,尹翠兰,等.氟康唑治疗重型肝炎和肝硬化合并真菌感染的疗效观察[J].肝脏,2013,18(9):653-654.
[12]徐淑凡,朱银芳,华忠,等.胸腺肽α1联合苦参素治疗丙型肝炎后肝硬化代偿期的临床观察[J].中外妇儿健康,2011,(8):293-294.
[13]周智宏,张国顺,刘培光,等.低剂量短效干扰素联合胸腺肽α1治疗失代偿期丙型肝炎肝硬化临床效果观察[J]中国综合临床,2012,28(8):861-863.
[14]孙颖,赵旭.白蛋白水平对除自发性腹膜炎外的肝硬化合并感染者的影响[J].临床肝胆病杂志,2015,(1):57.
[15]余永勤,刘汉勤,陈谭昇,等.人免疫球蛋白治疗肝硬化合并感染105例[J].世界华人消化杂志,2013,21(23):2344-2348.