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目的:探讨血浆置换(PE)与血浆灌流(PP)联合治疗肝衰竭的疗效和安全性,以及其对炎症因子和肝功能的影响。方法:选择2014年2月至2016年2月我院收治的98例肝衰竭患者为研究对象,按随机数字表法分为实验组和对照组,每组各49例。实验组行PE联合PP治疗,对照组行单纯PE治疗。采用全自动生化分析仪检测治疗前后患者肝功能指标;采用酶联免疫吸附法(ELISA)检测血清中炎症因子C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平。对比两组患者临床总有效率、不良反应发生率以及治疗前后肝功能指标和炎症因子水平。结果:实验组临床总有效率为91.84%,显著高于对照组的73.47%,差异有统计学意义(P<0.05)。实验组不良反应发生率为10.20%,明显低于对照组的38.78%,差异有统计学意义(P<0.05)。治疗后两组患者血清谷丙转氨酶(ALT)、总胆红素(TBIL)和血氨(NH3)水平明显下降(均P<0.05),白蛋白(ALB)和凝血酶活动度(PTA)明显上升(均P<0.05),治疗后实验组血清ALT、TBIL和NH3水平均低于对照组,ALB和PTA水平均高于对照组,差异具有统计学意义(均P<0.05)。治疗后血清中炎症因子CRP、TNF-α、IL-6水平均低于治疗前,实验组血清CRP、TNF-α、IL-6水平均低于对照组(均P<0.05)。结论:PE与PP联合治疗肝衰竭具有较好的疗效,且不良反应发生率较低,可有效清除炎症因子,改善肝功能,提高患者生存质量。
Objective: To investigate the efficacy and safety of combination of plasma exchange (PE) and plasma perfusion (PP) in the treatment of hepatic failure and its effects on inflammatory factors and liver function. Methods: From February 2014 to February 2016, 98 patients with liver failure who were treated in our hospital were selected as research objects. According to the random number table, the patients were divided into experimental group and control group, with 49 cases in each group. The experimental group was treated with PE combined with PP and the control group with simple PE. Serum levels of inflammatory cytokines C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA) (IL-6) levels. Compare the total effective rate of the two groups of patients, the incidence of adverse reactions and liver function indicators before and after treatment and levels of inflammatory cytokines. Results: The total effective rate of the experimental group was 91.84%, which was significantly higher than that of the control group (73.47%), the difference was statistically significant (P <0.05). The incidence of adverse reactions in the experimental group was 10.20%, which was significantly lower than that in the control group (38.78%), the difference was statistically significant (P <0.05). Serum alanine aminotransferase (ALT), total bilirubin (TBIL) and blood ammonia (NH3) levels were significantly decreased in both groups after treatment (all P <0.05), albumin (ALB) and thrombin activity (PTA) (All P <0.05). After treatment, the levels of serum ALT, TBIL and NH3 in the experimental group were lower than those in the control group. The levels of ALB and PTA in the experimental group were significantly higher than those in the control group (all P <0.05). Serum levels of CRP, TNF-α and IL-6 in the serum after treatment were lower than those before treatment. The levels of serum CRP, TNF-α and IL-6 in the experimental group were lower than those in the control group (all P <0.05). Conclusion: The combined treatment of PE and PP has a good curative effect on liver failure, and the incidence of adverse reactions is low, which can effectively eliminate inflammatory factors, improve liver function and improve the quality of life of patients.