摘要
目的探究血浆置换在肝癌患者不同原因所致高胆红素血症中的疗效。方法选取2022年7月至2023年7月赣州市人民医院收治的84例肝癌患者作为研究对象,根据高胆红素血症的发生原因分为肝衰竭组、胆道梗阻组及免疫治疗相关性肝炎组,每组28例。3组均在常规综合治疗后接受血浆置换治疗。比较3组治疗前后肝功能指标、凝血指标、血小板计数及临床疗效。结果治疗后,3组总胆红素、谷丙转氨酶、总胆汁酸水平均低于治疗前,白蛋白水平高于治疗前,免疫治疗相关性肝炎组总胆红素、总胆汁酸水平均低于肝衰竭组、胆道梗阻组,胆道梗阻组总胆红素、总胆汁酸水平均低于肝衰竭组,差异有统计学意义(P<0.05)。治疗后,3组凝血酶原活动度高于治疗前,血小板计数低于治疗前,差异有统计学意义(P<0.05);治疗后,3组凝血酶原活动度和血小板计数比较差异无统计学意义。3组4周治疗总有效率和12周生存率比较差异无统计学意义。结论血浆置换对肝癌肝衰竭、胆道梗阻、免疫治疗相关性肝炎所致高胆红素血症患者均有效果,但对肝癌胆道梗阻、免疫治疗相关性肝炎所致高胆红素血症的治疗效果更佳。
Objective To explore the efficacy of plasma exchange in hyperbilirubinemia caused by different causes in patients with liver cancer.Methods 84 patients with liver cancer admitted to Ganzhou People's Hospital from July 2022 to July 2023 were selected as the study subjects,and they were divided into the liver failure group,biliary obstruction group and the immunotherapy-related hepatitis group according to the causes of hyperbilirubinemia,with 28 cases in each group.All three groups received plasmapheresis after conventional combined therapy.The results of liver function index,coagulation index,platelet count and clinical efficacy were compared among the three groups before and after treatment.Results After treatment,total bilirubin,alanine aminotransferase and total bile acid levels among the three groups were lower than before treatment,albumin level was higher than before treatment,total bilirubin and total bile acid levels in the immunotreatment-related hepatitis group were lower than those in liver failure group and biliary obstruction group,and total bilirubin and total bile acid levels in biliary obstruction group were lower than those in liver failure group,the differences were statistically significant(P<0.05).After treatment,prothrombin activity among the three groups was higher than before treatment,and platelet count was lower than before treatment,the differences were statistically significant(P<0.05);after treatment,there was no significant difference in prothrombin activity and platelet count among the three groups.There were no significant differences in the 4-week total response rate and 12-week survival rate among the three groups.Conclusion Plasmapheresis is effective in patients with hepatic failure,biliary obstruction and hyperbilirubinemia caused by immunotherapy,but it is more effective in the treatment of hepatic biliary obstruction and hyperbilirubinemia caused by immunotherapy.
作者
曾春云
吴宇婷
温茹春
ZENG Chunyun;WU Yuting;WEN Ruchun(Department of Blood Transfusion,Ganzhou People's Hospital,Ganzhou,Jiangxi,341000,China)
出处
《当代医学》
2024年第19期165-168,共4页
Contemporary Medicine
基金
赣州市指导性科技计划项目(20222ZDX7888)。
关键词
血浆置换
肝癌
肝衰竭
胆道梗阻
免疫治疗相关性肝炎
肝功能
凝血功能
血小板计数
Plasma exchange
Liver cancer
Liver failure
Biliary obstruction
Immunotherapy-associated hepatitis
Liver function
Coagulation function
Platelet count
