目的 探讨在血源紧张条件下采用半量血浆置换(PE)联合双重血浆分子吸附系统(DPMAS)治疗肝衰竭患者的疗效.方法 40例肝衰竭患者接受半量PE联合DPMAS(对照组),另40例接受更少量PE联合DPMAS治疗(观察组),观察两组患者近期疗效.结果 在治疗后,两组患者肝功能较前明显好转,但观察组患者血清TBIL水平为(144.6±69.5)μmol/L,显著高于对照组的(120.8±65.4)μmol/L,血清ALB水平为(30.3±5.2)g/L,显著低于对照组的(33.5±5.2)g/L(P<0.05);经过2周内科综合治疗后,患者腹胀、恶心等消化道症状和乏力较前明显好转,PTA较前改善.对照组有效率为75.0％,观察组有效率为72.5％,两组比较差异无统计学意义(x2=0.208,P>0.05);在行人工肝治疗过程中,发生皮疹、低血糖和口唇周围麻木等,经对症处理后恢复.结论 少量血浆PE联合DPMAS治疗肝衰竭早中期患者也有一定的疗效.

肝纤维化是各种肝病进展至肝硬化、肝癌常见病理过程,肝纤维化的重要发生机制为肝星状细胞激活及细胞外基质在肝组织大量沉积.现已明确,早期肝纤维化可通过临床干预完全逆转,阻止肝硬化、肝癌的发生,一旦发展至肝硬化、肝癌治疗效果差,不可逆转.准确诊断肝纤维化有重大临床意义,诊断方法包括侵入性及无创性检查.前者为肝穿刺后活组织病理检查,是当前肝纤维化的诊断"金标准";后者有血清学检测及血清学模型、影像学的检查、分子生物学检测等诊断技术.通常将以上几种检查方法联合使用,以提高检测的准确率.

As a common clinical syndrome of severe liver disease,liver failure is extremely fatal.Its treatment includes comprehensive medical treatment,non-biological artificial liver support system, liver transplantation and biological stem cell transplantation.As an important treatment for the transition from early liver failure patients to liver transplantation,non-biological artificial liver has now been recognized and widely used at home and abroad.This article focuses on the commonly used non-biological artificial liver treatment are reviewed.

Objective To study the clinical features of patients with scrub typhus and provide scientific basis for clinical diagnosis and treatment. Methods Clinical data of patients with scrub typhus in the First Affiliated Hospital of Kunming Medical University from January 2016 to December 2016 were collected. Epidemiological data, clinical manifestations, laboratory findings, image examination results, treatment and outcome were retrospectively analyzed. Results The clinical manifestations included 59 cases (100.0％) with fever, 44 cases (74.6％) with headache, 39 cases (66.1％) with chills, 34 cases (57.6％) with muscle and joint pain, 29 cases (49.2％) with prostration, 49 cases (83.1％) with eschar or ulcer, 42 cases (71.2％) with lymphadenectasis, 23 cases (39.0％) with hepatosplenomegaly. Laboratory test results: 51 cases (86.4％) had normal or elevated white blood cell count, 50 cases of eosinophil reduced (84.7％), 27 cases of blood platelet (PLT) reduced (45.8％), 33 cases of albumin reduced (55.9％), 50 cases of alanine aminotransferase (ALT) increased (84.7％), 48 cases of aspartate aminotransferase (AST) increased (81.4％), and 56.1％ (23/41) of the patients with triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3) and free thyroxine (FT4) levels significantly lowered, with predominantly free FT3 reduction (82.6％,19/23); C reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and ferritin were increased in 93.9％(46/49), 35.4％ (17/48), 64.9％ (24/37), and 83.8％ (31/37) of the patients, and 95.6％(43/45) was accompanied with chest radiographic abnormalities. Tetracycline, doxycycline and azithromycin treatment were all effective. Conclusions The clinical manifestations of patients with scrub typhus, involving multisystem, are diverse and thyroid hormones decrease is observed. Early diagnosis and treatment is the key to improve the prognosis of patients with scrub typhus.