Effect and safety of plasma exchange combined with plasma bilirubin absorption in the treatment of liver failure associated with hepatitis B virus / 新乡医学院学报

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.