血浆置换联合持续性肾脏替代治疗对HBV相关慢加急性肝衰竭合并急性肾损伤患者预后的影响

姚运海; 甘建和; 赵卫峰

doi:10.3969/j.issn.1001-5256.2019.05.026

血浆置换联合持续性肾脏替代治疗对HBV相关慢加急性肝衰竭合并急性肾损伤患者预后的影响

DOI: 10.3969/j.issn.1001-5256.2019.05.026

1. 苏州大学附属第一医院感染科
2. 苏州大学附属第一医院肝病ICU

基金项目:

医学科学研究基金(YWJKJJHKYJJ-G17016)；

详细信息

中图分类号: R575.3;R512.62;R692
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出版历程
- 收稿日期: 2018-11-23
- 出版日期: 2019-05-20

Effect of plasma exchange combined with continuous renal replacement therapy on the prognosis of patients with HBV-related acute-on-chronic liver failure and acute kidney injury

Department of Infectious Diseases & Liver Intensive Care Unit, The First Affiliated Hospital of Soochow University

Research funding:

摘要

摘要: 目的探索血浆置换（PE）联合持续性肾脏替代治疗（CRRT）对HBV相关慢加急性肝衰竭（ACLF）合并急性肾损伤（AKI）患者预后的影响。方法回顾性分析2013年8月-2017年8月苏州大学附属第一医院收治的198例HBV相关ACLF合并AKI患者临床资料,根据血液净化技术分组,分为单纯药物治疗组（A组,n=68）,PE组（B组,n=56）,PE联合CRRT组（C组,n=74）。收集患者入院时的临床资料:性别,年龄,住院期间血液净化治疗前后生化指标:TBil、Alb、SCr、血清钠（Na）、INR、WBC、PLT、红细胞比容等,常见合并症,血液净化治疗方法。治疗前后计算肌酐清除率（Ccr）、肾小球滤过率（eGFR）、MELD-Na评分。正态分布的计量资料3组间比较采用单因素方差分析,组内治疗后比较采用配对t检验,组间比较采用两样本t检验;非正态分布的计量资料3组间比较采用Kruskal-Wallis H检验,组内治疗后比较采用Wilcoxon秩和检验,组间比较采用Mann-Whitney U检验;计数资料3组间比较采用χ2检验。生存时间和生存结局影响因素分析采用Co...
- 肝功能衰竭 /
- 肝炎病毒,乙型 /
- 肾功能不全 /
- 血浆置换 /
- 肾替代疗法 /
- 预后
Abstract: Objective To investigate the effect of plasma exchange ( PE) combined with continuous renal replacement therapy ( CRRT) on the prognosis of patients with HBV-related acute-on-chronic liver failure ( ACLF) and acute kidney injury ( AKI) . Methods A retrospective analysis was performed for the clinical data of 198 HBV-ACLF-AKI patients who were admitted to The First Affiliated Hospital of Soochow University from August 1, 2013 to August 1, 2017. According to the technique of blood purification, they were divided into pharmacotherapy group ( group A with 68 patients) , PE group ( group B with 56 patients) , and PE + CRRT group ( group C with 74 patients) .Related clinical data on admission were collected, including sex, age, biochemical parameters after blood purification ( total bilirubin, albumin, serum sodium, international normalized ratio, white blood cell count, platelet count, and hematocrit) , common complications, and blood purification method. Creatinine clearance rate ( CCR) , estimated glomerular filtration rate ( eGFR) , and MELD combined with serum sodium concentration ( MELD-Na) were calculated before and after treatment. A one-way analysis of variance was used for comparison of normally distributed continuous data between three groups; the paired t-test was used for comparison within one group before and after treatment, and the two samples t-test was used for comparison between groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between three groups; the paired samples Wilcoxon signed rank test was used for comparison within one group before and after treatment, and the Mann-Whitney U test was used for comparison between groups. The chi-square test was used for comparison of categorical data between three groups. The Cox proportional-hazards regression model was used to investigate the influencing factors for survival time and outcome. Results Before treatment, there were significant differences between the three groups in sex, age, blood biochemical parameters, eGFR, CCR, complications, and MELD-Na ( all P > 0. 05) . Groups B and C had significant increases in eGFR and CCR and a significant reduction in MELD-Na after treatment ( group B: Z =-2. 81, Z =-3. 67, t = 6. 07, all P < 0. 05;group C: Z =-5. 81, Z =-4. 05, t =-6. 90, all P < 0. 05) , and there were no significant differences in eGFR, CCR, and MELD-Na between groups B and C after treatment ( all P > 0. 05) . The regression analysis showed that eGFR, CCR, and MELD-Na after blood purification were influencing factors for the survival indices of ACLF-AKI patients ( all P < 0. 05) . The risk of death and cumulative risk gradually increased over the time of hospitalization. Conclusion PE alone or in combination with CRRT can significantly improve the renal function of ACLF-AKI patients, but the combination treatment has no obvious advantages. The improvement in renal function after blood purification directly affects the prognosis of ACLF-AKI patients, and the risk of death and cumulative risk gradually increase over the time of hospitalization.
- liver failure /
- hepatitis b virus /
- renal insufficiency /
- plasma exchange /
- renal replacement therapy /
- prognosis

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参考文献(25)

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