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两种人工肝对HBV相关慢加急性肝功能衰竭疗效和细胞因子的影响

作者：陈月桥 1 农桂东 2 梁潇月 1 凌春萍 1

单位：1.广西中医药大学第一附属医院肝病科南宁 530023 2.广西田东县中医院肝病科广西田东 531500

关键词：人工肝肝炎乙型慢加急性肝功能衰竭细胞因子

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出版年,卷(期):页码：2015,7(4):73-77

摘要：

摘要：目的探讨两种非生物型人工肝对HBV相关慢加急性肝功能衰竭患者的临床疗效及细胞因子
的影响。方法选取2012年12月至2015年4月广西中医药大学第一附属医院住院的97例乙型肝炎相关
慢加急性肝功能衰竭患者，分为血浆置换（PE）组50例、血浆置换联合持续血液滤过（PEF）组47
例。比较两组患者治疗前、治疗后的肝功能、血氨、血肌酐、肿瘤坏死因子-α、白细胞介素-6、白
细胞介素-10等指标的变化。结果 ①治疗后两组患者临床症状均有不同程度的改善，PEF组好转率为
76.5%（36/47），高于PE组的56.0%（28/50），差异有统计学意义（χ 2 = 4.578，P = 0.032）；②与
治疗前比较，治疗后PE组和PEF组TBil（t = 3.746，3.826；P = 0.000，0.000）、ALT（t = 5.123，
4.881；P = 0.000，0.000）、AMMO（t = 2.802，6.996；P = 0.006，0.000）、INR（t = 1.996，
2.038；P = 0.049，0.044）、Cr（t = 2.187，4.802；P = 0.031、0.000）均显著降低，ALB显著升高
（t = 2.300，3.065；P = 0.024，0.003），差异有统计学意义；治疗后两组间比较，PEF组AMMO和
Cr下降更多，差异有统计学意义（t = 2.111，2.152；P = 0.037，0.034）；③与PEF治疗后比较，PEF
组TNF-α、IL-6、IL-10水平较低，差异有统计学意义（t = 2.012，2.234，2.339；P = 0.047，0.027，
0.021）。结论 PE更适用于乙型肝炎相关慢加急性肝功能衰竭的早期治疗；而PEF不仅可以明显改善
该类患者的肝功能和凝血功能，在清除血氨、血肌酐和炎性因子方面疗效更优，更适合中期肝衰竭
的治疗。

Abstract: Objective To investigate the influence of two non-biological artificial liver on cytokines and
clinical effect of patients with hepatitis B related acute-on-chronic liver failure. Methods Total of 97 chronic
hepatitis B patients with acute-on-chronic liver failure in the First Affiliated Hospital of Guangxi University
of Chinese Medicine from December 2012 to April 2015 were selected and divided into PE group (50 cases)
and PEF group (47 cases). The liver function, blood ammonia, serum creatinine, tumor necrosis factor
alpha, interleukin-6 and interleukin-10 were detected and compared between the two groups before and after
treatment. Results ①The clinical symptoms improved in different degree in two groups, the recovery rate of
PEF group (76.5%) was higher than that of PE group (56%), the difference was statistically significant (χ 2 =
4.578, P = 0.032). ②Compared with before treatment, TBil (t = 3.746, 3.826; P = 0.000, 0.000), ALT (t = 5.123,
4.881; P = 0.000, 0.000), AMMO (t = 2.802, 6.996; P = 0.006, 0.000), INR (t = 1.996, 2.038; P = 0.049, 0.044)
and Cr (t = 2.187, 4.802; P = 0.031, 0.000) decreased and ALB (t = 2.300, 3.065; P = 0.024, 0.003) increased
significantly after treatment in both groups. After treatment, the levels of AMMO and Cr in PE and FEF group
decreased significantly, and there were statistical difference (t = 2.111, 2.152, P = 0.037, 0.034). ③After
treatment, compared with PEF group, the levels of TNF-α, IL-10 and IL-6 were much lower in PE group,
the difference was statistically significant (t = 2.012, 2.234, 2.339, P = 0.047, 0.027, 0.021). Conclusions
PE was more suitable for the early treatment in patients with acute-on-chronic liver failure associated with
hepatitis B virus infection. PEF was more suitable for the treatment of middle liver failur, because it can not
only obviously improve the hepatic function and coagulation function, but also reduce the blood ammonia,
creatinine and inflammatory cytokines.

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