目的:观察血浆置换(plasma exchange,PE)、血浆胆红素吸附(plasma specific bilirubin adsorption,PBA)与PE+PBA(联合组)治疗乙型肝炎肝衰竭的临床疗效,探讨乙型肝炎肝衰竭的最佳人工肝治疗方法.方法:回顾性分析乙型肝炎肝衰竭患者150例...目的:观察血浆置换(plasma exchange,PE)、血浆胆红素吸附(plasma specific bilirubin adsorption,PBA)与PE+PBA(联合组)治疗乙型肝炎肝衰竭的临床疗效,探讨乙型肝炎肝衰竭的最佳人工肝治疗方法.方法:回顾性分析乙型肝炎肝衰竭患者150例,分为PE组、PBA组、联合组,观察3组患者治疗前后丙氨酸转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、白蛋白(albumin,ALB)、凝血酶原时间(prothrombin time,PT)、凝血酶原时间活动度(prothrombin time activity,PTA)、肌酐(creatinine,Cr)和血氨的水平,并观察不良反应的发生率.结果:(1)联合组总有效率65.45%,高于PE组和PBA组的62.5%和59.58%,但差异无统计学意义(P>0.05);(2)PE组、PBA组、联合组患者治疗前及治疗后4hTBIL分别为:410.3mol/L±208.6mol/Lvs292.5mol/L±175.4mol/L,432.7mol/L±242.5mol/Lvs298.8mol/L±201.7mol/L,468.2mol/L±241.6mol/Lvs288.5mol/L±184.5mol/L,治疗后3组TBIL均明显下降(P<0.05),下降幅度3组间差异无意义;(3)联合组和PE组治疗后PT缩短,PTA升高(P<0.05),两组间差异无意义(P>0.05);(4)3组患者治疗后血氨均显著降低(P<0.05),但3组间无显著统计学差异(P>0.05);(5)3组患者治疗后Cr均下降(P<0.05),但3组间差异无统计学意义(P>0.05);(6)未发生严重不良反应;(7)单次血浆用量,联合组1107.1mL±212.3mL,明显少于PE组的2911.5mL±352.3mL(P<0.05).结论:PE+PBA应用血浆量少,治疗乙型肝炎肝衰竭安全、有效.展开更多
Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI ...Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI than those without cirrhosis. The hepatorenal syndrome type of AKI (HRS–AKI), a spectrum of disorders in prerenal chronic liver disease, and acute tubular necrosis (ATN) are the two most common causes of AKI in patients with chronic liver disease and cirrhosis. Differentiating these conditions is essential due to the differences in treatment. Prerenal AKI, a more benign disorder, responds well to plasma volume expansion, while ATN requires more specific renal support and is associated with substantial mortality. HRS–AKI is a facet of these two conditions, which are characterized by a dysregulation of the immune response. Recently, there has been progress in better defining this clinical entity, and studies have begun to address optimal care. The present review synopsizes the current diagnostic criteria, pathophysiology, and treatment modalities of HRS–AKI and as well as AKI in other chronic liver diseases (non-HRS–AKI) so that early recognition of HRS–AKI and the appropriate management can be established.展开更多
文摘目的:观察血浆置换(plasma exchange,PE)、血浆胆红素吸附(plasma specific bilirubin adsorption,PBA)与PE+PBA(联合组)治疗乙型肝炎肝衰竭的临床疗效,探讨乙型肝炎肝衰竭的最佳人工肝治疗方法.方法:回顾性分析乙型肝炎肝衰竭患者150例,分为PE组、PBA组、联合组,观察3组患者治疗前后丙氨酸转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、白蛋白(albumin,ALB)、凝血酶原时间(prothrombin time,PT)、凝血酶原时间活动度(prothrombin time activity,PTA)、肌酐(creatinine,Cr)和血氨的水平,并观察不良反应的发生率.结果:(1)联合组总有效率65.45%,高于PE组和PBA组的62.5%和59.58%,但差异无统计学意义(P>0.05);(2)PE组、PBA组、联合组患者治疗前及治疗后4hTBIL分别为:410.3mol/L±208.6mol/Lvs292.5mol/L±175.4mol/L,432.7mol/L±242.5mol/Lvs298.8mol/L±201.7mol/L,468.2mol/L±241.6mol/Lvs288.5mol/L±184.5mol/L,治疗后3组TBIL均明显下降(P<0.05),下降幅度3组间差异无意义;(3)联合组和PE组治疗后PT缩短,PTA升高(P<0.05),两组间差异无意义(P>0.05);(4)3组患者治疗后血氨均显著降低(P<0.05),但3组间无显著统计学差异(P>0.05);(5)3组患者治疗后Cr均下降(P<0.05),但3组间差异无统计学意义(P>0.05);(6)未发生严重不良反应;(7)单次血浆用量,联合组1107.1mL±212.3mL,明显少于PE组的2911.5mL±352.3mL(P<0.05).结论:PE+PBA应用血浆量少,治疗乙型肝炎肝衰竭安全、有效.
文摘Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI than those without cirrhosis. The hepatorenal syndrome type of AKI (HRS–AKI), a spectrum of disorders in prerenal chronic liver disease, and acute tubular necrosis (ATN) are the two most common causes of AKI in patients with chronic liver disease and cirrhosis. Differentiating these conditions is essential due to the differences in treatment. Prerenal AKI, a more benign disorder, responds well to plasma volume expansion, while ATN requires more specific renal support and is associated with substantial mortality. HRS–AKI is a facet of these two conditions, which are characterized by a dysregulation of the immune response. Recently, there has been progress in better defining this clinical entity, and studies have begun to address optimal care. The present review synopsizes the current diagnostic criteria, pathophysiology, and treatment modalities of HRS–AKI and as well as AKI in other chronic liver diseases (non-HRS–AKI) so that early recognition of HRS–AKI and the appropriate management can be established.
