| Objective:To discuss the safety and efficacy of plasma exchange combined with hepatitis B immunoglobulin in the treatment of acute-on-chronic liver failure and evaluate the curative effect.Methods:Retrospective analysis of 98 cases of hepatitis B related acute-on-chronic liver failure from the first people’s Hospital of Kunming from October 2007 to January 2016. The plasma exchange group is defined as Group A, and the plasma exchange group combined with hepatitis B immunoglobulin group are defined as Group B. To assess the the therapeutic safety by observing the adverse reactions or complications of the the two kinds of schemes in the process of plasma exchange or after the end of treatment, and evaluate the effect of two schemes by monitoring the indicator changes of the two groups of the patients (such as TBIL, ALT, ALB, INR,HB V-DNA and serum NH3) before and after treatment, clinical amelioration rate of behind 1week at the end of the time of plasma exchange and short-term survival rate (2w,4 w). Using SPSS17.0 software for statistical analysis, using t-test for measurement data, using chi square test for count data, using the Kaplan Meier method for survival analysis, using the log rank test for the survival rates comparison between two groups, evaluating the clinical curative effect of two therapeutic regimens in the treatment of acute-on-chronic liver failure.Results:Plasma exchange was performed in the 98 patients, and the plasma exchange was carried out for 198 times. Hypotension occurred in the 8 patients during the plasma exchange, including 5 cases in group A and 3 cases in group B. The 5 cases had convulsion,4 cases in group A and 1 case in group B. Urticaria occurred in 4 cases, including 2 cases in group A and 2 cases in group B. After symptomatic treatment, the plasma exchange were completed smoothly, without severe complications. The 12 cases were appeared congestion and ecchymosis in skin and mucosa at the intubation after plasma exchange, including 6 cases in group A,6 cases group B, unincorporated the gastrointestinal bleeding. One case was occurred the secondary infection in intubation in group A. The catheter-associated bloodstream infections did not occur after antibiotic treatment, the secondary infection did not occur in the group B and the plasma exchange is relatively safe. There was no statistically significant difference(P>0.05) between regimen A and regimen B about the TBIL and ALT after plasma exchange, on the second day after plasma exchange,and the difference was statistically significant (P<0.05) after the 5th D, 1w, and 2w after plasma exchange. There were no significant differences (P>0.05) after the plasma exchange, the 2nd D and 5th D after the plasma exchange about INR and NH3, and the difference was statistically significant (P<0.05) on the 1st w, and 2nd w after plasma exchange. There was the statistical difference (P<0.05) after plasma exchange, on the 2nd D,5th D,1st w and 2nd w after plasma exchange about HBV-DNA. There was the statistical difference (P<0.05) between regimen A and regimen B in a week at the end of the plasma exchange on the clinical amelioration rate, and there were significant differences(P<0.05) in the two groups of A and B regimens about clinical amelioration rate. The cumulative survival rate of the 2nd w and 4th w after admission treatment were statistically significant differences between the group A and B(P<0.05).Conclusion:1、A, B two treatment regimens can relieve the symptoms and signs of the patients to a certain extent, improve the blood biochemical indicators (TBIL, ALT, INR, NH3), but the two programs have no significant difference on the effect of albumin.2、Compared with A scheme, the scheme B can neutralize the free hepatitis B virus in the peripheral serum more timely and effectively, reduce the HBV-DNA load in the peripheral blood after the plasma exchange, reduce that the hepatocytes are attacked for the second time from the HBV, provide for the favourable conditions for the regeneration of hepatocytes.3、Compared with the regimen A, the regimen B could improve the clinical amelioration rate of patients in one week after the last plasma exchange.4、Compared with the regimen A, the scheme B could improve the survival rate of the patients with HBV-ACLF (2w,4w), provide a temporary transition waiting for liver transplantation for the part of patients, and its influence on long-term survival needs further studying.5、Plasma exchange combined with hepatitis B immunoglobulin in the treatment of in the treatment of acute-on-chronic liver failure is a safe and effective treatment method, and it’s worthy of further promotion in clinical practice. |
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