中国血液净化

›› 2005, Vol. 4 ›› Issue (12): 660-662.

• 论著 • 上一篇    下一篇

血浆置换对重型病毒性肝炎患者血液学指标的影响

易建华 翁志宏 王 晖 朱祥珍 罗端德   

  1. 430022 武汉，华中科技大学同济医学院附属协和医院感染性疾病科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-12-12 发布日期:2005-12-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-12-12 Published:2005-12-12

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摘要： 目的 研究血浆置换治疗对重型病毒性肝炎患者内环境的影响以避免治疗相关并发症的发生。方法 应用血浆置换治疗华中科技大学同济医学院附属协和医院感染性疾病科重型病毒性肝炎患者62例，分别于治疗前后检测患者的血液生化指标肝肾功能和电解质、免疫学指标血清补体及细胞因子TNFα和IL-6水平、常规血液学指标外周血细胞计数和红细胞形态以及反映凝血功能状态的国际标准化指数INR。结果 血浆置换治疗后，重型肝炎患者的肝功能明显改善，血清胆红素和ALT、AST水平明显下降，前白蛋白水平明显上升。血清钠水平上升而钙水平降低，提示血浆置换治疗可以纠正低钠血症并应注意钙剂的补充。血清补体C3、C4水平上升而补体活性CH50则无明显变化，细胞因子TNFα和IL-6水平明显降低。凝血功能状态明显改善，而外周血细胞计数和红细胞形态则不受血浆置换治疗的影响。结论 血浆置换治疗可以改善重型肝炎患者的肝功能和凝血功能状态，减轻异常免疫反应，维持内环境稳定。

关键词: 血浆置换, 重型病毒性肝炎, 肝功能, 补体, 细胞因子

Abstract:

Objective To investigate the affection on inner environment of patients with severe viral hepatitis using plasma exchange (PE) and avoid the complication correlated with PE. Methods A total of 62 patients with severe viral hepatitis were enrolled for treatment with PE. Function of liver and kidney and serum electrolyte, complement and complement activity, cytokines level of TNF-α and IL-6, international normalized ratio were determined, and test data of the subsequent day after PE was compared with the data before treatment. The form of peripheral blood RBC was also observed before and after PE. Results The liver function index of the patients was significant improved and hyponatremia was corrected after PE therapy. Serum calcium level was reduced, so it was essential for supplement of calcium during PE. Serum concentration of complement C3 and C4 was increased, but serum level of TNF-α and IL-6 was decreased. Thromboplastic function was improved after PE. The configuration of peripheral blood RBC remained stable. Conclusion Plasma exchange therapy can recover the liver function and improve the thromboplastic mechanism, and decrease the abnormal immunological reaction of patients with severe viral hepatitis, and maintain stabilization of inner environment. The PE therapy is safe and effective for severe viral hepatitis.

Key words: Severe Viral Hepatitis, Liver Function, Complement, Cytokine

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