目的 观察腹膜透析(peritoneal dialysis,PD)治疗肝衰竭临床疗效及对炎症细胞因子影响。 方法 回顾性队列研究，纳入56例肝衰竭患者，PD组30例、非生物型人工肝血浆置换(plasma exchange,PE)组26例，比较2组治疗前后临床疗效、丙氨酸氨基转移酶(ALT)、血氨(AMMO)、总胆红素(TBIL)、凝血酶原时间(INR)、血肌酐(Cr)、血浆白蛋白(ALB)、白细胞介素6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)，以及终末期肝病模型(model for end-stage liver disease,MELD)评分、肝功能Child-Turotte-Pugh(CTP)评分。主要观察终点90天全因死亡率，绘制 Kaplan-Meier生存曲线。 结果 治疗后ALT、AMMO、TBIL、INR、Cr、IL-6、PCT、TNF-α、MELD及CTP评分与治疗前比，PD组显著改善(Z/t值分别为4.440、6.084、7.750、5.227、4.947、11.649、10.060、14.596、5.930、6.355，均P＜0.001)，PE组显著改善(Z/t值分别为4.360、4.191、7.972、3.245、3.122、8.404、10.806、12.596、3.949、4.466，P值分别为＜0.001、＜0.001、＜0.001、0.003、0.004、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001)；2组间治疗后上述指标比较无统计学差异(F/χ2值分别为0.039、0.488、0.147、0.000、1.407、0.002、0.010、0.027、54.637、3.841，P值分别为0.844、0.488、0.703、0.991、0.241、0.960、0.920、0.870、0.523、0.798)。治疗后PE组ALB显著高于PD组(F=8.061,P=0.005)。治疗3月总有效率2组比较无统计学差异(χ2=0.025，P=0.611)。但PD组总费用较PE组显著降低(Z=13.500,P =0.001)。 结论 PD与PE治疗肝衰竭同等有效，值得临床推广。
赵文喜
,
李莉
,
张小友
,
代建荣
,
陈红玉
,
张丽珠
,
蒋红梅
,
艾辉
,
陈峰
,
欧亚林
,
周竹
. 腹膜透析治疗肝衰竭疗效及对患者炎症细胞因子的影响[J]. 中国血液净化, 2023
, 22(06)
: 432
-437
.
DOI: 10.3969/j.issn.1671-4091.2023.06.007
Objective To observe the clinical efficacy of peritoneal dialysis (PD) on liver failure and its effect on inflammatory cytokines. Methods This is a retrospective and cohort study, including 56 patients with liver failure, of which 30 patients used PD (PD group) and 26 patients treated with abiotic artificial liver plasma exchange (PE group). The clinical efficacy, alanine aminotransferase (ALT), blood ammonia (AMMO), total bilirubin (TBIL), prothrombin time (INR), serum creatinine (Cr), plasma albumin (ALB), interleukin-6 (IL-6), procalcitonin (PCT), tumor necrosis factor-α (TNF-α) before and after the treatment, and the scores of the model for end-stage liver disease (MELD) and Child-Turotte-Pugh (CTP) were compared between the two groups. The primary end point was all-cause mortality in 90 days. Kaplan-Meier survival curve was plotted. Results After the treatment, ALT, AMMO, TBIL, INR, Cr, IL-6, PCT, TNF-α, and the scores of MELD and CTP improved significantly in both groups as compared with those before treatment (For PD group, Z/t=4.440, 6.084, 7.750, 5.227, 4.947, 11.649, 10.060, 14.596, 5.930 and 6.355 respectively; P<0.001. For PE group, Z/t=4.360, 4.191, 7.972, 3.245, 3.122, 8.404, 10.806, 12.596, 3.949 and 4.466, respectively; P<0.001, <0.001, <0.001, 0.003, 0.004, <0.001, <0.001, <0.001, <0.001 and <0.001 respectively), and the improvements had no statistical significances between the two groups (F/c2=0.039, 0.488, 0.147, 0.000, 1.407, 0.002, 0.010, 0.027, 54.637 and 3.841 respectively; P=0.844, 0.488, 0.703, 0.991, 0.241, 0.960, 0.920, 0.870, 0.523 and 0.798 respectively). After the treatment, ALB was significantly higher in PE group than in PD group (F=8.061, P=0.005). The overall effectiveness rate after the treatment for 3 months had no statistical significance between the two groups (χ2=0.025,P=0.611), but the expenses were less in PD group than in PE group (Z=13.500,P=0.001). Conclusion PD and PE are equally effective in the treatment of liver failure, which is worthy of clinical promotion.
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