ABSTRACT
Objective To observe the clinical efficacy of artificial liver plasma bilirubin adsorption for treatment of patients with severe viral hepatitis B (HBV). Methods A retrospective study was conducted, the 120 patients with severe HBV B and their historical data of having undergone treatment of artificial liver plasma bilirubin adsorption admitted to Department of Respiration of Mianyang Central Hospital from August 2015 to August 2017 were collected, and there were 68 cases in the cirrhotic group and 52 cases in the non-cirrhotic group. The indexes of liver function and coagulation function before and after the treatment of artificial liver plasma bilirubin adsorption were collected; the differences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamine transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein (TP), albumin (Alb), globulin (Glo), prothrombin time (PT), prothrombin activity (PTA), total bilirubin (TBil) and indirect bilirubin (IBil), total bile acid (TBA), etc were compared between cirrhotic group and the severe hepatitis B non-cirrhotic group. Results The levels of ALT, AST, ALP, LDH after artificial liver plasma bilirubin adsorption therapy were lower than those before the treatment [ALT (U/L): 138.8±26.2 vs. 993.4±185.2, AST (U/L): 121.7±119.9 vs. 798.7±226.8, ALP (U/L): 129.7±8.1 vs. 178.9±14.1, LDH (μmol·L-1·s-1·L-1): 4.50±0.32 vs. 8.15 ±1.75, all P < 0.05], PTA was higher than that before the treatment [(43.2±25.6)% vs. (30.0±16.1)%, P < 0.05]. After the treatment, the decline rate of ALP, TBil, and TBA of non-cirrhotic group was higher than those in cirrhotic group (ALP: 34.20% vs. 17.80%, TBil: 39.10% vs. 18.10%, TBA:30.70% vs. 5.00%, P < 0.05), the elevation rate of PTA in non-cirrhotic group was also higher than that in cirrhotic group (52.50% vs. 25.10%, P < 0.05). Conclusion Artificial liver plasma bilirubin adsorption therapy is effective for treatment of patients with severe HBV B, particularly the effect being good on the early severe viral HBV B non-cirrhotic group.
ABSTRACT
Objective To investigate the clinical effect of plasma exchange(PE)combined with plasma bilirubin ad-sorption(PBA)in the treatment of liver failure associated with hepatitis B virus(HBV). Methods A total of 75 patients with HBV related liver failure were selected from May 2014 to May 2016 in the People's Hospital of Guangxi Zhuang Autonomous Region. The patients were divided into PE group,PBA group and PE combined PBA(PE + PBA)group according to their will, 25 cases in each group. The levels of serum alanine aminotransferase(ALT),total bilirubin(TBIL),albumin(ALB),prothrom-bin time(PT),prothrombin activity(PTA),serum creatinine(SCr)and blood ammonia were compared among the three groups before and after treatment,and the adverse reactions were observed. Results There was no significant difference in serum ALT,TBIL,ALB and SCr levels among the three groups before treatment(P > 0. 05). The levels of serum ALT,TBIL and SCr after treatment were significantly lower than those before treatment in the three groups(P < 0. 05). The level of serum ALB af-ter treatment was significantly higher than that before treatment in the PE group and the PE + PBA group(P < 0. 05),but the level of serum ALB after treatment was significantly lower than that before treatment in the PBA group (P < 0. 05). There was no significant difference in serum ALT,TBIL and SCr levels among the three groups after treatment(P > 0. 05). The serum ALB levels in the PE group and the PE + PBA group was significantly higher than that in the PBA group after treatment(P <0. 05). There was no significant difference in serum ALB level between the PE group and the PE + PBA group after treatment (P > 0. 05). There was no significant difference in the PT,PTA and blood ammonia level among the three groups before treat-ment(P > 0. 05). Compared with before treatment,the PT shortened significantly after treatment,the PTA increased significant-ly,and the blood ammonia level decreased significantly in the three groups(P < 0. 05). Compared with the PBA group,the PT shortened significantly,the PTA increased significantly,and the blood ammonia level decreased significantly in the PE group and the PE + PBA group after treatment(P < 0. 05). There was no significant difference in PT,PTA and blood ammonia level between the PE group and the PE + PBA group after treatment(P > 0. 05). The plasma consumption of patients in the PE group and the PE + PBA group was(2908. 11 ± 287. 91)and(1107. 24 ± 213. 67)mL respectively,the plasma consumption in the PE + PBA group was significantly less than that in the PE group(t = 23. 782,P < 0. 05). The treatment time of patients in the PE group,the PBA group and the PE + PBA group was(2. 90 ± 0. 87),(3. 02 ± 0. 77),(3. 22 ± 0. 69)h respectively;there was no significant difference in the treatment time among the three groups(F = 1. 881,P > 0. 05). The total effective rate in the PE group,the PBA group and the PE + PBA group was 64. 0％(16 / 25),56. 0％(14 / 25),64. 0％(16 / 25),respectively;there was no significant difference in the total effective rate among the three groups(χ2 = 7. 281,P > 0. 05). The incidence of eryth-ra,chill and rigor,numbness and convulsion,infection and errhysis in the PE group was 32. 0％(8 / 25),28. 0％(7 / 25), 16. 0％(4 / 25),8. 0％(2 / 25),8. 0％(2 / 25),respectively. The incidence of erythra,chill and rigor,numbness and convul-sion,infection and errhysis in the PBA group was 16. 0％(4 / 25),16. 0％(4 / 25),12. 0％(3 / 25),4. 0％(1 / 25),4. 0％(1 /25),respectively. The incidence of erythra,chill and rigor,numbness and convulsion,infection and errhysis in the PE + PBA group was 20. 0％(5 / 25),20. 0％(5 / 25),12. 0％(3 / 25),4. 0％(1 / 25)and 4. 0％(1 / 25),respectively. The incidence of erythra,chill and rigor,numbness and convulsion,infection and errhysis in the PBA group and the PE + PBA group was signifi-cantly lower than that in the PE group(P < 0. 05). There was no significant difference in the incidence of erythra,chill and rig-or,numbness and convulsion,infection and errhysis between the PBA group and the PE + PBA group(P > 0. 05). Conclusion PE combined with PBA is effective,safe and feasible in the treatment of HBV related liver failure,and it can reduce plasma consumption.