摘要
目的观察血浆置换对慢性乙型重型肝炎(CSHB)患者肝功能、凝血指标、炎症指标、HBV-DNA、高迁移率族蛋白B(HMGB1)及终末期肝病模型(MELD)分值的影响。方法选择复旦大学附属中山医院青浦分院2017年5月-2019年10月收治的72例CSHB患者,依据治疗方式将其分为观察组(血浆置换+常规内科治疗,n=39)和对照组(常规内科治疗,n=33)。比较分析两组治疗前后肝功能、凝血指标、炎症指标、HBV-DNA、HMGB1及MELD分值,综合评价两组疗效。结果观察组总有效率(92.31%)高于对照组(72.73%),差异有统计学意义(P<0.05)。治疗前两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBIL)、血浆凝血酶原时间(PT)、凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、纤维蛋白(FIB)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、Slit2蛋白、转化生长因子-β1(TGF-β1)、HBV-DNA、HMGB1及MELD分值比较差异无统计学意义(P>0.05)。治疗后两组ALT、AST、ALP、TBIL、PT、APTT、IL-6、TNF-α、TGF-β1、Slit2蛋白、HBV-DNA、HMGB1及MELD分值均降低,观察组降低幅度较对照组高,差异均有统计学意义(P<0.05);治疗后两组PTA、FIB均升高,观察组升高幅度较对照组高,差异均有统计学意义(P<0.05)。结论对慢性乙型重型肝炎患者而言,血浆置换疗法可显著改善其肝功能、凝血功能及炎症程度,并降低机体MELD分值、HBV-DNA和HMGB1浓度,疗效显著,是一种重要辅助治疗手段。
Objective To observe the effects of plasma exchange on liver functions,coagulation indexes,inflammatory indexes,HBV-DNA,high mobility group box-1 protein(HMGB1),and mode for end-stage liver disease(MELD)of patients with chronic severe hepatitis B(CSHB).Methods A total of 72 CSHB patients admitted to Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from May 2017 to October 2019 were selected.According to the treatment method,they were divided into the observation group(plasma exchange+routine medical treatment,n=39)and the control group(routine medical treatment,n=33).Liver functions,coagulation indexes,inflammation indexes,HBV-DNA,HMGB1 and MELD scores of the two groups before and after the treatment were compared and analyzed,and the efficacy of the two groups was comprehensively evaluated.Results The total effective rate of the observation group(92.31%)was higher than that of the control group(72.73%)(P<0.05).Before treatment,the alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),total bilirubin(TBIL),plasma prothrombin time(PT),prothrombin activity(PTA),activated partial thromboplastin time(APTT),fibrin(FIB),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),Slit2 protein,transforming growth factor-β1(TGF-β1),HBV-DNA,HMGB1 and MELD scores were not significantly different between the two groups(P>0.05).After the treatment,ALT,AST,ALP,TBIL,PT,APTT,IL-6,TNF-α,TGF-β1,Slit2 protein,HBV-DNA,HMGB1 and MELD scores of the two groups all decreased,and the decrease degree of the observation group was higher than that of the control group(P<0.05);PTA and FIB level in both groups all increased,and the increase degree of the observation group was higher than that of the control group(P<0.05).Conclusions For patients with chronic severe hepatitis B,plasma exchange therapy could significantly improve their liver functions,coagulation functions and inflammation degrees.It could also reduce MELD scores,HBV-DNA and HMGB1concentrations of the body,with significant efficacy,which might be an important auxiliary treatment.
作者
胡洁华
沈春娟
张斌
HU Jie-hua;SHEN Chun-juan;ZHANG Bin(Department of Infectious Diseases,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)
出处
《热带医学杂志》
CAS
2022年第3期405-408,415,共5页
Journal of Tropical Medicine
