Study On The Changes Of Immune Function And Curative Effect Of CRRT Combined With PE In The Treatment Of Hepatitis B-Related Slow And Acute Liver Failure

Objective: To study the clinical efficacy and immune function of continuous renal replacement therapy(CRRT)combined with plasma exchange(PE)and PE alone for the treatment of hepatitis B-related acute liver failure(ACLF),and to explore the treatment of hepatitis B-related ACLFa more effective way.Methods: Sixty patients with hepatitis B-related chronic acute liver failure who were treated in Linyi City People’s Hospital from October 2016 to October 2018 were enrolled as the main subjects of the study.They were divided into control group and study according to the principle of random enrollment.Group,the number of patients in each group was 30 cases.In the control group,30 patients were treated with PE on the basis of traditional medical treatment.30 patients in the study group were treated with CRRT and PE on the basis of traditional medical treatment.The changes of t lymphocyte subsets(CD4+T cells,CD8+ T cells and CD4+/CD8+)were analyzed at baseline,2 weeks and 4 weeks,respectively,at baseline,1 week,2 weeks and 4 weeks.The data of the experimental study were analyzed and analyzed.The changes of alanine aminotransferase,aspartate aminotransferase,total bilirubin,blood ammonia,PTA,INR,serum potassium,serum sodium and serum creatinine were compared between the two groups,and the two groups of patients were statistically analyzed.MELD score and prognosis survival at baseline and after 4 weeks.Results: After analysis and comparison,it was found that the biochemical parameters of the study group were significantly better after treatment than the control group(p<0.05).T lymphocyte subsets were counted at 2 and 4 weeks respectively.The CD4+ T lymphocytes in the study group increased.Compared with the control group(p<0.05),the CD8+ T lymphocytes in the study group decreased significantly,and there was statistical significance between the two groups(p<0.05).Statistical analysis of CD4+/CD8+ changes was statistically significant(p<0.05).At 1 week,the total bilirubin and serum potassium,serum sodium and serum creatinine were improved.More advantageous,there is statistical significance between the two groups.The changes of alanine aminotransferase and aspartate aminotransferase were not obvious.After 2 weeks,the improvement of the biochemical indicators in the study group was significantly better(p<0.05),but for the recovery of coagulation function,there was no significant difference between the two groups in the first 2 weeks,statistically meaningless(p>0.05).After 4 weeks,the improvement of coagulation function in the study group was better than that of the control group(p<0.05).The changes of t lymphocyte subsets at baseline level were compared between the two groups.There was no statistical difference(p>0.05).The patients in the study group also had a significantly better meld score after treatment than the control group(p<0.05).Finally,the survival rate of the two groups was statistically analyzed.The survival rate of the study group was 80%,which was significantly higher than that of the control group(63.3%).Conclusion: Continuous renal replacement therapy(crrt)combined with plasmapheresis(pe)in the treatment of hepatitis B-related slow and acute liver failure is better than single-use plasma exchange,biochemical indicators are significantly improved,survival rate is improved;crrt combined with pe treatment can be Effectively remove inflammatory factors,stabilize the body’s internal environment,block systemic inflammatory response syndrome,improve the body’s immune function,and promote the rehabilitation of patients;this study provides a new idea for individualized choice of artificial liver combined treatment of liver failure mode.