ABSTRACT
Objective To investigate the short-term efficacy of plasma exchange(PE),PE combined with double plasma molecule absorption system(PE+DPMAS) for treating severe hepatitis B(SHB).Methods The clinical data in 70 patients with SHB were retrospectively analyzed.The patients were divided into the PE group and PE+-DPMAS group according to different treatment modes.The clinical symptoms,liver function,coagulation function,blood routine,renal function and electrolytes changes,score decrease of model for end-stage liver disease(MELD) before and after treatment were compared between the two groups.Results After treatment,the alimentary tract symptoms were improved,the grade of hepatic encephalopathy was reduced and MELD score was decreased,but there was no statistically significant difference in the short-term effective rate between the two groups(P＞0.05).After treatment ALT,TBIL,RBC,Hb and PLT in the two groups were decreased significantly(P＜0.05);the ALB level in the PE+DPMAS group was decreased,while K+ and C1 were increased(P＜0.05);the PTA and ALB levels in the PE group were increased,while WBC was decreased in the PE group(P＜0.05).Conclusion The two kinds of treatment method PE and PE-+DP-MAS are effective in treating SHB.PE+-DPMAS can reduce the plasma usage and improve serum K+,Cl-levels;PE is superior to PE+DPMAS in the aspects of improving coagulation function and ALB level.
ABSTRACT
Objective To investigate the clinical efficacy of plasma exchange (PE)in the treatment of liver failure.Methods A retro-spective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hos-pital.Thirty -three patients in PE group received PE in addition to medical comprehensive treatment,and 30 patients in control group were treated with medical comprehensive treatment.Clinical symptoms,complications,and the changes in biochemical markers of liver function were observed after 2 weeks of treatment,post -treatment outcomes were evaluated by 3 -month followed -up,and the influential factors for efficacy were analyzed.Experimental data were expressed as mean ±standard deviation,continuous data were compared by t test,and cate-gorical data were analyzed by chi -square test or Fisher′s exact test.Results Symptoms such as fatigue,poor appetite,and abdominal dis-tension were significantly relieved after PE.Post -treatment serum alanine aminotransferase (ALT)and total bilirubin (TBil)levels were significantly lower compared with pre -treatment levels (390.48 ±536.52 U /L vs 81.03 ±47.58 U /L and 479.27 ±130.01 μmol /L vs 244.64 ±151.05 μmol /L,P 0.05).Patients in PE group had a significantly higher improve-ment rate (χ2 =8.276,P <0.005)and a significantly lower mortality rate (χ2 =13.258,P <0.005)compared with the control group.The efficacy of PE was found to be correlated with pre -treatment TBil level,complications,bilirubin enzyme separation,and age ≥40 years (P <0.05).TBil and bilirubin enzyme separation were independent risk factors affecting the efficacy of PE (P <0.05,OR =1.01 and 8.75).Adverse reactions occurred in 8 cases during PE treatment,and disappeared after symptomatic treatment.Conclusion PE is a safe and effective treatment for liver failure,and holds promise for clinical application.TBil level and bilirubin enzyme separation are independ-ent risk factors affecting the efficacy of PE.
ABSTRACT
Objective To evaluate the clinical effect of artificial liver support system (ALSS)on serum high -sensitivity C -reactive pro-tein (hs -CRP)level and investigate the influence of the change in hs -CRP level on clinical prognosis among patients with hepatic failure. Methods Patients were recruited into three groups:group one included 60 patients who received ALSS due to hepatic failure;group two in-cluded 37 patients with hepatic failure without ALSS treatment;and group three included 37 patients with chronic hepatitis B.The serum levels of hs -CRP were measured in groups two and three,and in group one before and after ALSS treatment.Comparison of continuous data between groups was made by t test,and comparison of categorical data was made by chi -square test.Results The levels of hs -CRP in group one before treatment and in groups two and three were 12.89 ±9.39,12.22 ±9.73,and 2.83 ±6.79,respectively.No significant difference in hs -CRP level between group one and group two was observed (P >0.05).However,the hs -CRP level in group three was significantly different from those in group one and group two (P <0.001 ).The improvement rate in group one after ALSS treatment (78.3%)was significantly higher compared with that in group two (54.05%)(χ2 =6.315,P <0.05).ALSS treatment (t =5.179,P <0.05).ALSS treatment was selectively effective in a subgroup of patients and greatly decreased the hs -CRP level in these patients (t =5.344,P =0.000),resulting in a significant difference from the patients who were unresponsive to ALSS treatment (t =2.368,P =0.038).Conclusion Artificial liver support system can decrease the hs -CRP level in patients with hepatic failure.Serum level of hs -CRP can be used as a clinical indicator of disease progression and predict the clinical outcomes of ALSS in patients with hepatic failure.