摘要目的 探讨HB-H-6树脂血浆灌流治疗对重度黄疸患者预后的影响因素.方法 回顾性分析本院2006年10月至2010年7月住院接受HB-H-6树脂血浆灌流治疗的78例慢性肝性重度黄疸患者的资料,根据预后分为有效组(51例)及无效组(27例),采用多元logistic回归方法评价年龄、性别、住院天数、人工肝治疗次数、灌流前Child-Pugh积分、灌流前总胆红素(TBil)及平均TBil反弹率等因素对预后的影响作用.结果 78例患者人均接受HB-H-6树脂血浆灌流治疗(3.31±1.36)次.有效组灌流前Child-Pugh积分(分)、灌注前TBil水平(μmol/L)和平均TBil反弹率显著低于无效组[灌流前Child-Pugh积分:8.06±1.01比9.44±1.19,灌流前TBil:384.29±170.41比504.93±206.88,平均TBil反弹率:-(7.35±20.76)％比(37.32±23.22)％],且两组性别也存在明显差异(有效组男性30例、女性21例,无效组男性24例、女性3例,P＜0.05或P＜0.01).多因素logistic回归分析表明,性别和平均TBil反弹率是影响HB-H-6树脂血浆灌流治疗慢性肝性重度黄疸预后的独立危险因素,两者的偏回归系数β值分别为5.35和-2.82( X2=64.42,P=0.000).用平均TBil反弹率预测预后不良的受试者工作特征曲线下面积(AUC)为0.90 (0.82,0.97),平均TBil反弹率高于29.5％提示预后不良.灌流后无明显不良反应.结论 性别和平均TBil反弹率是决定HB-H-6树脂血浆灌流治疗慢性肝性重度黄疸预后疗效的独立危险因素,平均TBil反弹率高于29.5％提示预后不良.

abstractsObjective To invesigate the influencing factors of efficacy of plasma perfusion in patients with severe jaundice.Methods The clinical data of 78 patients with severe jaundice due to different causes receiving HB-H-6 resin plasma perfusion therapy admitted to Tianjin Third Central Hospital from October 2006 to July 2010 were retrospectively analyzed.Patients were divided into improved group ( n=51 ) and ineffective group ( n=27 ) according to outcomes.The effecting factors of prognosis,including age,sex,hospital stay days,number of perfusion therapy received,Child-Pugh scores before perfusion,total bilirubin (TBil) levels before perfusion,and mean TBil rebound rate were studied by univariate and multivariate logistic regression analysis.Results All 78 patients received (3.31 ±1.36) times of HB-H-6 resin plasma perfusion treatment.Child-Pugh score before perfusion,TBil (μmol/L) before perfusion and mean TBil rebound rate in improved group were significantly lower than those in ineffective group [Child-Pugh score before perfusion:8.06 ± 1.01 vs.9.44 ± 1.19; TBil before perfusion:384.29 ± 170.41 vs.504.93 ±206.88 ; mean TBil rebound rate:- (7.35 ± 20.76 )％ vs. ( 37.32 ± 23.22 )％ ].They were also significantly different in gender between two groups ( improved group:30 males,21 females; ineffective group:24 males,3 females,P＜0.05 or P＜0.01 ).Gender and mean TBil bounce rate were defined as independent significant factors influencing the clinical results by multivariate logistic regression analysis.Regression coefficient β were 5.35 and -2.82 for gender and mean TBil bounce rate respectively (x2=64.42,P=0.000).Receive operating characteristic curve (ROC curve) analysis showed that the area under the curve ( AUC ) was 0.90 (0.82,0.97 ),and mean TBil bounce rate higher than 29.5％indicated poor prognosis.No obvious side effects were observed after plasma perfusion.Conclusions Gender and mean TBil bounce rate were independent risk factors in treatment of severe jaundice with HB-H-6 resin plasma perfusion.Mean TBil bounce rate higher than 29.5％ indicated a poor prognosis.