摘要
目的 观察不同终末期肝病模型(MELD)评分的乙型肝炎病毒(HBV)相关性慢加急性肝衰竭(HBV-ACLF)患者行人工肝治疗的短期疗效。方法 回顾性收集121例行人工肝治疗的HBV-ACLF患者的临床资料,根据患者入院时的MELD评分中位数分为高MELD评分组(MELD评分>中位数,61例)和低MELD评分组(MELD评分≤中位数,60例)。比较两组患者的临床资料,治疗前后生化指标、MELD评分,治疗后短期疗效。结果 两组年龄、性别、体质量指数(BMI)、人工肝治疗次数、人工肝治疗模式比较差异无统计学意义(P>0.05)。低MELD评分组治疗后好转率为81.67%(49/60),高于高MELD评分组的63.93%(39/61),差异有统计学意义(χ^(2)=3.932,P=0.047<0.05)。两组治疗后不良反应发生率比较差异无统计学意义(P>0.05)。治疗前,高MELD评分组谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、白蛋白(ALB)、总胆汁酸(TBA)、胆碱酯酶(CHE)、钾离子(K^(+))、钙离子(Ca^(2+))、凝血酶原时间(PT)、国际标准化比值(INR)、白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)及MELD评分均较低MELD评分组差,差异具有统计学意义(P<0.05)。治疗前,高MELD评分组ALT、AST、TBil、TBA、CHE、PLT、MELD评分分别为(254.98±99.90)U/L、(264.53±63.08)U/L、(346.17±148.27)μmol/L、(226.23±90.29)μmol/L、(3582.48±1533.18)U/L、(135.11±75.80)×10^(9)/L、(77.98±5.51)分。低MELD评分组ALT、AST、TBil、TBA、CHE、PLT、MELD评分分别为(218.02±101.92)U/L、(192.77±87.92)U/L、(271.92±107.56)μmol/L、(189.17±74.62)μmol/L、(4209.23±1718.67)U/L、(170.47±90.36)×10^(9)/L、(68.09±4.45)分。治疗后,高MELD评分组ALT、AST、TBil、TBA、CHE、PLT、MELD评分分别为(104.33±121.85)U/L、(98.05±84.17)U/L、(197.89±116.60)μmol/L、(155.39±76.57)μmol/L、(5428.87±1674.44)U/L、(172.38±66.49)×10^(9)/L、(72.35±7.89)分。低MELD评分组ALT、AST、TBil、TBA、CHE、PLT、MELD评分分别为
Objective To observe the short-term efficacy of artificial liver therapy in patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF)with different models for endstage liver disease(MELD)score.Methods The clinical data of 121 HBV-ACLF patients undergoing artificial liver treatment were retrospectively collected.According to the median MELD score at admission,the patients were divided into high MELD score group(MELD scores>median,61 cases)and low MELD score group (MELD scores≤median,60 cases).The clinical data,biochemical indexes and MELD scores before and after treatment,and short-term efficacy after treatment were compared between the two groups.Results There was no statistically significant difference in age,gender,body mass index(BMI),frequency of artificial liver treatments and mode of artificial liver treatment between the two groups(P>0.05).The improvement rate after treatment was 81.67%(49/60)in the low MELD score group,which was higher than that of 63.93%(39/61)in the high MELD score group,and the difference was statistically significant(χ^(2)=3.932,P=0.047<0.05).There was no statistically significant difference in the incidence of adverse reactions after treatment between the two groups(P>0.05).Before treatment,alanine aminotrasferase(ALT),aspartate transaminase(AST),total bilirubin(TBil),albumin(ALB),total bile acids(TBA),cholinesterase(CHE),potassium ion(K+),calcium ion(Ca2+),prothrombin time(PT),international normalized ratio(INR),white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),and platelet count(PLT)in low MELD score group were worse than those in the low MELD score group,and the differences were statistically significant(P<0.05).Before treatment,ALT,AST,TBil,TBA,CHE,PLT,and MELD scores of the high MELD score group were(254.98±99.90)U/L,(264.53±63.08)U/L,(346.17±148.27)μmol/L,(226.23±90.29)μmol/L,(3582.48±1533.18)U/L,(135.11±75.80)×10^(9)/L,and(77.98±5.51)points;ALT,AST,TBil,TBA,CHE,PLT,and MELD scores of the low MELD score group were(218.
作者
吴慧慧
罗长柳
WU Hui-hui;LUO Chang-liu(Department of Infectious Diseases,Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,China)
出处
《中国实用医药》
2023年第13期7-11,共5页
China Practical Medicine
基金
广西壮族自治区卫生厅科研项目(项目编号:Z20190088)。
关键词
乙型肝炎病毒相关性慢加急性肝衰竭
人工肝
终末期肝病模型
血浆置换疗法
短期疗效
Hepatitis B virus-related acute-on-chronic liver failure
Artificial liver
Models for end-stage liver disease
Plasma exchange therapy
Short-term efficacy
