摘要
目的观察血浆置换(plasma exchange,PE)治疗三氯乙烯药疹样皮炎(medicamentosa-like of trichloroethylene,DMLT)合并重度肝损害的疗效。方法21例患者在内科综合治疗的基础上给予血浆置换治疗,观察临床疗效和并发症发生情况,监测治疗前后肝功能、凝血功能指标及肿瘤坏死因子-α(TNF-α)的变化情况。结果所有患者经血浆置换治疗后临床症状有不同程度缓解,有效率为100%;治疗前丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、直接胆红素(DBiL)、TNF-a,凝血酶原时问(PT),白蛋白(ALB)分别为1176.2±243.50U/L,897.30±98.62U/L,327.50±137.70mmol/L,181.43±89.32mmol/L,38.63±8.42pg/mL,20.32±5.06g/L,治疗后分别为384.61±78.60U/L,223.81±65.32U/L,132.45±69.57mmol/L,98.78±78.39mmol/L,9.84±2.69pg/mL,32.78±4.59g/L。差异有统计学意义(P<0.05),活化部分凝血酶原时问(APTT)、凝血酶时间(TT)、纤维蛋白原(FBG)治疗前分别为59.81±11.33S,26.87±10.42S,1.47±0.86g/L,治疗后分别为55.47±24.36S23.32±5.07S,1.59±0.55g/L,相比较无明显差异(P>0.05);1例因并发肺部诺卡菌感染死亡;21例患者共进行血浆置换治疗81次,出现不良反应2次。结论血浆置换治疗三氯乙烯药疹样皮炎合并重度肝功能衰竭疗效明显。
Objective To explore the therapeutic effect of plasma exchange in the treatment of patients with medicamentosa-like dermatitis due to trichloroethylene （DMLT） accompanied with severe hepatitis. Methods Twenty-one patients were treated with plasma exchange combined with conventional therapy. Hepatic function markers, coagulation tests and changes of clinical symptoms were compared. Results The patients＇ alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, tumor necrosis factor-α, prothrombin time, and albumin were 1176.2±243.50 U/L, 897.30±98.62 U/L, 327.50 ±137.70 mmol/L, 181.43±89.32 mmol/L, 38.63±8.42 pg/mL, and 20.32±5.06 g/L, respectively, before treatment, and were 384.61±78.60 U/L, 223.81±65.32 U/L, 132.45±69.57 mmol/L, 98.78±78.39 mmol/L, 9.84±2.69 pg/mL, and 32.78±4.59g/L （P 〈 0.05）, respectively, with the improvement of clinical symptoms after plasma exchange treatment. Activated partial thromboplastin time, thrombin time, and fibrinogen were 59.81±11.33 S, 26.7±10.42 S, and 1.47±0.86 g/L, respectively, before treatment, and were 55.47±24.36 S, 23.32±5.07 S, and 1.59±0.55 g/L, respectively, after plasma exchange treatment, but without statistical significances （P 〉 0.05）. Twenty cases （95.2%） survived, and one patient died of pulmonary nocadia infection. Plasma exchange was totally performed 81 times in the 21 patients, with the occurrence of adverse reactions in 2 times. Conclusions Plasma exchange is safe and effective in the treatment of patients with DMLT.
出处
《中国血液净化》
2013年第4期199-202,共4页
Chinese Journal of Blood Purification
基金
深圳市科技局资助项目(201103373)
国家重点临床科室建设项目
关键词
血浆置换
三氯乙烯药疹样皮炎
肝功能衰竭
Plasma exchange
Medicamentosa-like dermatitis due to trichloroethylene
Severe hepatitis
