乙肝相关性慢加急性肝衰竭患者在肝移植等待期接受血浆置换的疗效分析*

doi:10.3969/j.issn.1671-2587.2022.01.012

临床输血与检验 ›› 2022, Vol. 24 ›› Issue (1): 52-57.DOI: 10.3969/j.issn.1671-2587.2022.01.012

乙肝相关性慢加急性肝衰竭患者在肝移植等待期接受血浆置换的疗效分析*

刘业, 毛家玺, 刘聪, 宋晨梦, 陈蕾宇, 郭闻渊, 滕飞, 唐晓峰

200003 上海,海军军医大学长征医院输血科（刘业,宋晨梦,陈蕾宇,唐晓峰）; 海军军医大学长征医院肝脏外科（毛家玺,刘聪,郭闻渊,滕飞）

收稿日期:2021-11-16 发布日期:2022-01-27
通讯作者: 滕飞,男,主治医师,博士,主要从事肝移植围手术期管理,（E-mail）tengfei@smmu.edu.cn。
共同通信作者：唐晓峰,男,副主任医师,硕士,主要从事输血管理工作,（E-mail）jack_tangxf@163.com。
作者简介:刘业（1987-）,女,江苏盐城人,主管技师,本科,主要从事战创伤快速输血与策略的研究,（E-mail）liuye19870406@163.com。
基金资助:
*本课题受国家自然科学基金面上项目（No.81971503）、国家自然科学基金青年项目（No.81702923）、长征医院军事医学科研专项（No.2019CZJS222）资助

Efficacy Analysis of Plasma Exchange on Patients with Hepatitis B Associated Chronic Acute Liver Failure Awaiting Liver Transplantation

LIU Ye, MAO Jia-xi, LIU Cong, et al

Department of Blood Transfusion,Changzheng Hospital, Naval Medical University,Shanghai 200003

Received:2021-11-16 Published:2022-01-27

摘要/Abstract

摘要： 目的研究肝移植等待期接受血浆置换（plasma exchange,PE）的乙肝相关性慢加急性肝衰竭（hepatitis B virus associated acute-on-chronic liver failure,HBV-ACLF）患者的预后影响因素。方法回顾性分析上海长征医院2018年6月~2021年6月在等待肝移植期间接受PE的HBV-ACLF患者的基本信息（性别、年龄、血型）、PE的次数、用量、PE前后指标的变化情况、PE相关不良反应及预后情况等。结果 51例在肝移植等待期接受PE的HBV-ACLF患者纳入分析,多因素分析显示PE前后血氨差值（blood ammonia,ΔBA）是影响PE治疗等待肝移植的HBV-ACLF患者90天及长期疗效的独立危险因素,而PE前血小板计数（platelet count,PLT）是影响患者长期疗效的独立危险因素。ROC曲线分析显示PE前后BA降低4%可使患者获得较好的预后。结论血浆置换前后血氨的变化幅度是预测血浆置换疗效以及HBV-ACLF患者预后的有效指标,对于血浆资源的合理配置和使用具有指导意义。

关键词: 血浆置换, 人工肝, 乙型肝炎, 慢加急性肝衰竭, 动态血氨

Abstract: Objective To investigate the influence of plasma exchange on prognostic factors of patients with hepatitis B associated chronic acute liver failure（HBV-ACLF）awaiting liver transplantation. Methods A retrospective analysis was performed on patients with HBV-ACLF who received PE while waiting for liver transplantation in Shanghai Changzheng Hospital from June 2018 to June 2021,including the basic information（gender,age,blood type）of the patients,number and dosage of PE,changes of indicators before and after PE,adverse reactions related to PE and the prognosis of the patients. Results Fifty-one cases were included in this research. Multivariate analysis showed that blood ammonia（BA）difference before and after PE was an independent risk factor for 90 days and long-term outcomes in HBV-ACLF patients awaiting liver transplantation treated with PE,and platelet count before PE was also an independent risk factor for long-term outcomes in these patients. ROC curve calculation showed that after PE reduction of BA to 4% of that before PE might result in a better prognosis. Conclusion The change range of BA before and after PE is an effective indicator to predict the efficacy of PE and the prognosis of HBV-ACLF patients,which has guiding significance for the rational allocation and usage of plasma resources.

Key words: Plasma exchange, Artificial liver treatment, Hepatitis B, Acute-on-chronic liver failure, Dynamic blood ammonia

中图分类号:

R575.3

刘业, 毛家玺, 刘聪, 宋晨梦, 陈蕾宇, 郭闻渊, 滕飞, 唐晓峰. 乙肝相关性慢加急性肝衰竭患者在肝移植等待期接受血浆置换的疗效分析*[J]. 临床输血与检验, 2022, 24(1): 52-57.

LIU Ye, MAO Jia-xi, LIU Cong, et al. Efficacy Analysis of Plasma Exchange on Patients with Hepatitis B Associated Chronic Acute Liver Failure Awaiting Liver Transplantation[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2022, 24(1): 52-57.

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乙肝相关性慢加急性肝衰竭患者在肝移植等待期接受血浆置换的疗效分析*

Efficacy Analysis of Plasma Exchange on Patients with Hepatitis B Associated Chronic Acute Liver Failure Awaiting Liver Transplantation

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