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《Chinese Journal of Blood Transfusion》 2016-01
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Curative effect of plasma exchange in the treatment of patients with severe hepatitis

GAO Meng;FU Yunfeng;ZHANG Yanan;LIU Jing;ZHAO Guosheng;MA Jingqi;LIU Fengxia;ZHANG Junhua;WEN Xianhui;GUI Rong;Department of Blood Transfusion,The Third Xiangya Hospital of Central South University;Department of Hematology,The Third Xiangya Hospital of Central South University;  
Objective To investigate the effect of plasma exchange( PE),a kind of artificial liver support system( ALSS),and the change of blood biochemical indexes in the treatment of severe hepatitis,to observe the relations between prognoses of the patients treated with plasma exchange and their complications from severe hepatitis,to evaluate the safety of plasma exchange for treating severe hepatitis. Methods Clinical data on 69 patients with severe hepatitis were analyzed. On the basis of different therapies,these patients were divided into two groups: PE group and control group. The PE group used plasma exchange based on conventional indication,while the control group only used a comprehensive set of medication. Before the treatment and 24 hours after plasma exchange,the blood of the patients were taken to test the changes of patients' serum level in biochemical indices,such as PT,TT,ALT,AST,T-BILI,D-BILI,TBA,etc. Clinical symptoms and signs were observed. The efficiency of plasma exchange at different stage of severe hepatitis was analyzed. The effect of gender,biochemical parameters and complication from severe hepatitis was evaluated by univariate analysis. Results The clinical symptoms and signs of the patients in the experimental group improved significantly after plasma exchange. When comparing the experimental group and control group,coagulation function and liver function tests also improved: PT( s) 24. 5 ± 9. 19 vs.17. 8 ± 6. 71,TT( s) 16. 6 ± 3. 87 vs 17. 9 ± 11. 82,ALT( g / L) 281. 2 ± 271. 16 vs 69. 4 ± 91. 97,AST( g / L) 285. 8 ±247. 91 vs 64. 8 ± 43. 94,T-BILI( μmol / L) 407. 0 ± 178. 99 vs 238. 2 ± 143. 76,D-BILI( μmol / L) 316. 1 ± 131. 09 vs 167. 4± 110. 85,TBA( μmol / L) 141. 7 ± 83. 56 vs 140. 6 ± 86. 26. The overall desirable outcome of PE group was 56. 41%,of which the efficiencies of treatment in early,middle and late severe hepatitis were 81. 25%,53. 85%,and 20. 00%,respectively. In the control group,only 30. 00% achieved desirable outcome,of which the efficiencies in early,middle,late severe hepatitis were 41. 67%,40. 00%,12. 50%( P 0. 05).In PE group, the desirable outcome after treatment in the patients with spontaneous bacterial peritonitis was 70. 00%,while in the control group,the desirable outcome was 40. 00%.Conclusion Plasma exchange is an effective method to treat severe hepatitis. It is more effective in the early stage of liver failure,but not as much in the late stage. The efficiency of treatment on patients with spontaneous bacterial peritonitis in the PE group was better than the control group.
【Fund】: 国家科学自然基金面上项目(81470361和81573091)
【CateGory Index】: R575.1
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1 Ye Xiaoling;Cheng Shuquan;Graduate College, Guilin Medical University;;The research progress of non-bioartificial liver support system and its combination use in liver failure therapy[J];Chinese Journal of Clinicians(Electronic Edition);2014-11
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