网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
异甘草酸镁联合血浆置换治疗乙型肝炎病毒相关慢加急性肝衰竭的临床研究
作者:毛海鹰1  滕华安2  廖礼艳1  黄丽娜1  王曼玲1  姚玲3 
单位:1. 宜宾市第三人民医院 肝病感染病科, 四川 宜宾 644000;
2. 宜宾市第三人民医院 肝胆外科, 四川 宜宾 644000;
3. 宜宾市第二人民医院 感染科, 四川 宜宾 644000
关键词:肝功能衰竭 异甘草酸镁 血浆置换 
分类号:R512.62
出版年·卷·期(页码):2019·47·第一期(38-41)
摘要:

目的:探讨异甘草酸镁联合血浆置换治疗乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者的临床疗效。方法:选取60例HBV-ACLF患者,其中30例在内科综合治疗的基础上接受血浆置换治疗(对照组);另外30例在对照组治疗的基础上接受异甘草酸镁治疗(治疗组)。动态观察两组患者的病死率、肝功能、血浆置换治疗次数等指标,所有患者均完成48周的随访。结果:各观察时间点的病死率治疗组均低于对照组,但差异无统计学意义(P>0.05)。治疗第1周末血清谷氨酸氨基转移酶(ALT)治疗组显著低于对照组(P<0.05);治疗第4周末治疗组血清ALT、总胆红素及国际标准化比值均显著低于对照组(P<0.05)。平均每例患者血浆置换治疗次数治疗组显著少于对照组(P<0.05)。结论:异甘草酸镁联合血浆置换治疗能快速改善HBV-ACLF患者的肝脏功能,缩短疗程,减少血浆置换次数。

Objective: To investigate the effect of isoglycyrrhizinate combined with plasma exchange in the treatment of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF). Methods: Sixty patients with HBV-ACLF were enrolled in this study and divided into two groups.Thirty patients in the control group were treated by internal comprehensive therapy combined with plasma exchange,and the other patients in the treatment group were treated with isoglycyrrhizinate on the basis of the control group. The mortality rates,liver functions and times of plasma exchange were observed dynamiclly during the treatment.All the patients were followed up for 48 weeks. Results: The mortality rate in the treatment group was slightly lower than that of the control group at each observation time point,but there were no statistical significance(P>0.05).The level of serum alanine aminotransferase(ALT) in the treatment group was significantly lower than that of the control group at the end of the first week of treatment(P<0.05).The levels of serum ALT, total bilirubin and international normalized ratio in the treatment group were all significantly lower than those of the control group at the end of the fourth week of treatment(P<0.05). Compared with the control group, the average times of plasma exchange in the treatment group were significantly fewer(P<0.05). Conclusion: Isoglycyrrhizinate combined with plasma exchange can rapidly improve liver functions,shorten the course of treatment and reduce the times of plasma exchange in patients with HBV-ACLF.

参考文献:

[1] 王晓晶,张小平,宁琴.肝衰竭的免疫发病机制[J].临床肝胆病杂志,2014,30(10):984-991.
[2] 李晨,万谟彬,王慧芬.核苷类似物治疗HBV相关慢加急性肝衰竭的研究进展[J].实用肝脏病杂志,2010,13(4):306-309.
[3] 刘洪,陈刚,甘雪梅.慢加急性肝衰竭治疗的新技术及其研究进展[J].临床肝胆病杂志,2015,31(9):1496-1500.
[4] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂志,2006,14(9):643-646.
[5] 丁滢,刘春梅.成分血浆滤过透析治疗肝功能衰竭32例疗效观察与护理[J].现代医学,2013,41(6):420-423.
[6] 杨方集,彭亮,高志良.乙型肝炎慢加急性肝衰竭诊疗的新策略与新进展[J].中华临床感染病杂志,2017,10(2):101-106.
[7] 李晓东,徐东平.HBV相关慢加急性肝衰竭免疫病理发病机制研究进展[J].实用肝脏病杂志,2015,18(3):317-320.
[8] 陈智,朱海红,杨英.细胞因子风暴与肝衰竭[J].临床肝胆病杂志,2014,30(10):981-984.
[9] 聂青和.糖皮质激素在肝衰竭治疗中的地位[J].中华肝脏病杂志,2012,20(6):414-415.
[10] 中华医学会感染病学分会,肝脏炎症及其防治专家共识专家委员会.肝脏炎症及其防治专家共识[J].中华临床感染病杂志,2014,7(1):4-12.
[11] WANG C Y,KAO T C,LO W H,et al.Glycyrrhizic acid and 18β-glycyrrhetinic acid modulate lipopolysaccharide-induced inflammatory response by suppression of NF-κB through PI3K p110δ and p110γ inhibitions[J].J Agric Food Chem,2011,59(14):7726-7733.
[12] 刘潇聪,陈耀凯,李晖,等.复方甘草酸苷对重型肝炎的治疗作用及机制研究[J].第三军医大学学报,2009,31(18):1806-1808.
[13] 毛海鹰,康涛,姚玲,等.甘草酸类制剂治疗慢性重型乙型肝炎疗效的Meta分析[J].临床肝胆病杂志,2015,31(1):63-67.
[14] 甘草酸制剂肝病临床应用专家委员会.甘草酸制剂肝病临床应用专家共识[J].中华实验和临床感染病杂志,2016,10(1):1-9.
[15] 中华医学会感染病学分会肝衰竭与人工肝学组.非生物型人工肝支持系统治疗肝衰竭指南(2009年版)[J].中华临床感染病杂志,2009,2(6):321-325.
[16] 茅益民,曾民德,陈勇,等.异甘草酸镁治疗ALT升高的慢性肝病的多中心、随机、双盲、多剂量、阳性药物平行对照临床研究[J].中华肝脏病杂志,2009,17(11):847-851.
[17] 刘晓慧,郭海清,张晶,等.非生物型人工肝技术及其临床应用新进展[J].临床肝胆病杂志,2013,29(9):661-665.
[18] 汪徐林,邵建国,陈智娴,等.人工肝支持系统治疗对慢加急性肝衰竭病死率影响的Meta分析[J].中国医师杂志,2016,18(3):338-346.
[19] 王宇明,李兰娟.《肝衰竭诊治指南(2012年版)》治疗进展的解读与探讨[J].中华临床感染病杂志,2013,6(2):77-80.
[20] CUI Y L,YAN F,WANG Y B,et al.Nucleoside analogue can improve the long-term prognosis of patients with hepatitis B virus infection-associated acute on chronic liver failure[J].Dig Dis Sci,2010,55(8):2373-2380.
[21] 高海兵,林明华,潘晨,等.核苷类药物治疗HBV相关慢加急性肝衰竭患者24个月的生存分析[J].中华肝脏病杂志,2015,23(1):17-22.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 266161 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541