The Evaluation Of Efficacy Effect Of "Improved" Plasma Exchange Combined Entecavir In The Treatment Of HBV Realated Acute-on-chronic Liver Failure

Objective:To disscuss the "improved" plasmapheresis combined with entecavir in the treatment of hepatitis B virus related acute-on-chronic liver failure,include the safety of clinical application,and the sanme time,to evaluate the clinical value and efficacy.Methods:Retrospective analysis of 102 cases of hepatitis B related acute-on-chronic liver failure from the first people’s Hospital of Kunming from 2008 to January 2017,and grouped according to the inclusion criteria,as follows:56 cases of HBV-ACLF patients as group A.which is in routine medical treatment and"improved" plasma exchange,combined with entecavir treatment;46 cases of HBV-ACLF patients as group B,with only "improvement" in plasmapheresis plus conventional medical treatment.Before the collection of indicators(such as TBIL,liver function,INR);and after finishing the plasma exchange,we continued to collect the 3thd,1nd w,4 nd w,12 nd w indicators(such as TBIL,AST,ALT.INR.).The statistical analysis is SPSS 17.0 software.The data were measured by T test,and the chi square test was used to count the data,and the survival rate between groups was compared by Log-rank test.At the same time,the efficacy of each group were analyzed observe the"improvedt" plasma exchange process and adverse reactions after treatment,to evaluate the safety for the "improved" plasma exchange combined entecavir in the treatment of HBV realated acute-on-chronic liver failureResults:The study included a total of 102 cases of HBV-ACLF patients,the group A included 56 patients,aged 28 to 68 years old(30 cases of male,26 cases of female),group B included 46 patients,aged 21 to 65 years old(27 cases of male,19 cases of female),and the plasma exchange was carried out for 351.In treatment process,the low blood pressure occurred in 15 cases,including 7 cases of group A,8 cases occurred in group B;9 cases had seizures,including 5 cases of group A,4 cases occurred in group B;13 cases had urticaria,6 cases in group A,7 cases occurred in group B;16 cases of fever.9 cases in group A.7 cases occurred in group B;secondary infection and acute pulmonary edema in 1 cases,all patients in the group B.After the treatment of symptomatic relief,such as diuretic and anti allergic treatment,"improved" plasma exchange was completed successfully.Through strict inclusion criteria,there was no significant difference in liver function(TBIL,AST,ALB,ALT),coagulation function(INR),HBV-DNA,blood NH3 before treatment(P>0.05).Follow up 3thd,group A compared with group B,regardless of TBIL,or AST.ALT.ALB,coagulation function(INR),HBV-DNA and blood NH3,the difference was statistically significant(P<0.05).Follow-up the 1stw,4ndw,12ndw,compared between the group A and group B,included the improvement of TBIL,AST,ALT,ALB,coagulation function(INR),HBV-DNA,and the blood NH3 were statistically significant(P<0.05).By comparing A and B clinical recovery in two groups after the treatment of 1thw(chi square test),and analyze the treatment of 4ndw and 12ndw were survival(Log-rank test),the results suggest that group A both in the clinical cure rate and survival rate were better than that of group BConclusions:1.A,B two treatment programs for patients with HBV-ACLF have a certain effect,improve the liver function(AST,ALT,etc.),reduce the TBIL,blood NH3 and other indicators,and reduce the signs and symptoms of patients.2.Group A(ALT,AST,ALB,etc.),blood NH3,coagulation function(INR)in the short term(1thw,4ndw)was slightly better than the group B,especially for HBV clearance was significantly better than the group B.3.The long-term efficacy of group A(12ndw)is better than group B,compared wit group B,the improvement of TBIL,AST,ALT,ALB,blood NH3 and INR showed a greater advantage for the group A,the long-term antiviral foundation combined with plasma exchange,both played a synergistic effect,and for the long-term effect of hepatitis B virus clearance was significantly higher than that of group B.4,For the clinical improvement rate and survival rate,compared between group A to group B for the HBV-ACLF,the short-term clinical improvement rate(1thw),as well as 4ndw,12ndw survival rate is better than the group B.5,Patients with acute liver failure should continue to adhere to the use of antiviral drugs,which can neutralize the serum free hepatitis B virus,and that can played a synergistic effect with the rule of medical treatment and plasma exchange synergies6,"Improved" plasma exchange in the treatment of HBV-ACLF curative effect is acceptable,it is worthy of clinical promotion,and need further study.7,The efficacy effect of "improved" plasma exchange combined entecavir in the treatment of HBV realated acute-on-chronic liver failure has a certain efficacy.both for patients with short-term clinical improvement rate,or for liver transplantation during the medical treatment,delay the disease,improve the patient index have a certain role in promoting,is worth popularizing in clinical long-term.