| Objectives: Chronic severe hepatitis is substantial necrosis of hepatocytes on the basis of chronic liver disease, resulting in metabolic disorders and the accumulation of toxic substances and decreasing the liver regeneration and repair. The effects of general medical treatment are worse. In recent years, many domestic and foreign scholars have carried out artificial liver support system (ALSS) to replace some liver function in order to treat chronic severe hepatitis. The efficacy of chronic severe hepatitis is improved. Plasma exchange (PE), a way of ALSS, is most widely used in China. In this study, we evaluated the role of PE on the treatment of chronic severe hepatitis and the security of this therapy through application of PE on the treatment of chronic severe hepatitis. At same time, we also analyzed the factors influencing its efficacy. Our study estimated the prognosis of patients with chronic severe hepatitis through the PE therapy, guide the next treatment and provide a reference for clinical practice.Methods: Analyze retrospectively the clinical data of 89 patients with chronic severe hepatitis in People Liberation Army (PLA) 202 Hospital enrolled during the 2000-2008. Patients were divided into two groups randomly. 41 cases received PE therapy were studied as treatment group, and 48 cases received other medical therapies served as control group. Exam the total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin (ALB), prothrombin activity (PTA), cholinesterase (CHE) in the serum. The results changed in blood ammonia before and after PE therapy, as well as the negative reflection. The clinical characteristics and curative effect and its influencing factors of these cases were studied. All data were analyzed by SP SS 16.0.Results: Results of liver function tests improved significantly in all subjects in 24 hours after PE therpy. The serum ALT, AST and TBIL levels declined significantly (P <0.05). The level of ALB, CHE and PTA increased significantly (P<0.05). Meanwhile ammonia was decreased significantly (P<0.01). In the 41 patients in treatment group, 20 patients were cured or improved (48.8%), 10 patients died, and 11 patients discharged of their own accords (51.2%). In the 48 patients of the control group, 13 patients were cured or improved (27.1%), 13 patients died, and 17 patients discharged of their own accords (72.9%). The curative effect of the treatment group was higher than which of the control group (P < 0.05).Patient's age, disease stage, type of complications would influence the curative effect of PE. 1. The prognosis of gerontal patients was poor. Between the patients older than 60-year-old and ones younger than 60-year-old, there was a significant difference of the efficiency rate (P<0.05). 2. The efficiency rate in early stages (76.9%) was much higher than that in middle stages (50.0%), as was the efficiency rate in middle stages which was much higher than that in end-stages (16.7%). 3. In the treatment group, two of eight patients with hepatic encephalopathy were improved (25%), all six patients with hepatorenal syndrome died, and four of seven patients with electrolyte disorder were improved (57.1%). But in the control group, the efficiency rate of hepatic encephalopathy was 16%, no improvement was found in the cases of hepatorenal syndrome, the electrolyte imbalance is improved by 60%. The difference was not significant between the two groups. In the treatment group, the efficiency of primary peritonitis is 58.7 %, and the efficiency of the control group is 14.3%. Comparing the two groups, the difference was significant (P < 0.05).Conclusions: Our study shows the PE is a safe and effective therapeutic means for chronic severe hepatitis. It can improve liver function in short-time and the successful rate of the rescue, moreover prolong the survival time in patients with. ineffective treatment. Ages, stages and complications of the patients were important factors that affect the treatment efficacy of PE therapy on chronic severe hepatitis. The prognosis of the patients'PE treatment would no be ideal if they are too old or at the end-stages or combining the complications of liver encephalopathy or hepatorenal syndrome.
|
PDF Full Text Request