Đặc điểm lâm sàng, cận lâm sàng và một số yếu tố liên quan tỷ lệ tử vong ở bệnh nhân suy gan cấp trên nền bệnh lý gan mạn do vi rút viêm gan B được điều trị lọc thay thế huyết tương

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Tác giả: Văn Nam Lê, Xuân Chính Nguyễn, Xuân Lâm Nguyễn, Văn Chung Phạm, Thị Như Huế Tô, Văn Sơn Trịnh, Viết Sáng Vũ

Ngôn ngữ: vie

Ký hiệu phân loại: 612.35 Biliary tract and liver

Thông tin xuất bản: Y dược Lâm sàng 108, 2022

Mô tả vật lý: 37-43

Bộ sưu tập: Metadata

ID: 500962

Thêm vào giỏ

Mô tả đặc điểm lâm sàng, cận lâm sàng và tìm hiểu một số yếu tố liên quan tỷ lệ tử vong ở bệnh nhân ở bệnh nhân suy gan cấp trên nền bệnh lý gan mạn do vi rút viêm gan B được điều trị lọc thay thế huyết tương. Đối tượng và phương pháp: Nghiên cứu mô tả tiến cứu kết hợp hồi cứu có theo dõi dọc 70 bệnh nhân viêm gan mạn và xơ gan do vi rút viêm gan B có suy gan được điều trị bằng liệu pháp lọc thay thế huyết tương tại Bệnh viện Trung ương Quân đội 108 từ 01/2018-06/2022. Kết quả: Trong số 70 bệnh nhân, 58/70 (82,9%) là nam, 43/70 (61,4%) dưới 60 tuổi. 100% ca bệnh có biểu hiện mệt mỏi và vàng da. Phù và xuất huyết ngoài da gặp lần lượt 24,3% và 18,6%. Xét nghiệm bilirubin toàn phần và NH3 trong máu tăng cao lần lượt là 443,6 ± 120,2µmol/L và 108,7 ± 70,4µmol/L
tỷ lệ prothrombin máu 34,4 ± 18,7%. Tỷ lệ prothrombin <
40%, NH3 ≥ 100µg/dL và bilirubin toàn phần ≥ 500µmol/L gặp tỷ lệ tương ứng là 71,4%, 48,6%, 42,9% và 28,6%. Tỷ lệ sống 28 ngày của nhóm viêm gan mạn là 10/27 (37,0%) cao hơn so với nhóm xơ gan 13/43 (30,2%), tuy nhiên sự khác biệt là không có ý nghĩa thông kê với p=0,371. Tỷ lệ prothrombin <
40% và tăng NH3 ≥ 100µg/L là những yếu tố có liên quan đến tăng tỷ lệ tử vong. Kết luận: Biểu hiện lâm sàng thường gặp là vàng da, phù và xuất huyết. Đặc điểm xét nghiệm đặc trưng được ghi nhận là prothrombin giảm <
40%
albumin giảm dưới 3This study intended to describe clinical features, laboratory data and related factors for outcomes of chronic hepatitis B with or without cirrhosis who suffered from liver failure and treated with plasma exchange. Subject and method: The research is a prospective and retrospective descriptive study, that enrolled 70 participants suffering from liver failure related to hepatitis B virus and treated with therapeutic plasma exchange at 108 Military Central Hospital from January 2018 to June 2022. Result: In total, 58/70 (82.9%) of the participants were male and 43/70 (61.4%) of patients were less than 60 years old. All of the patients were fatigue and jaundice. Edema and skin bleeding were 24.3% and 18.6%, respectively. Serum total bilirubin and ammonia increased to 443.6 ± 120.2µmo/L and 108.7 ± 70.4µmo/L, respectively. The decreasing of prothrombin was 34.4 ± 18.7%. The rates of prothrombin <
40%
albumin ≤ 30g/L
NH3 ≥ 100µg/dL and total bilirubin ≥ 500µmo/L were 71.4%, 48.6%, 42.9% and 28.6%, respectively. The 28-day survival of the chronic hepatitis cases was 10/27 (37.0%) higher than that of the cirrhosis cases 13/43 (30.2%), however, the difference was not statistically significant (p=0.371). A prothrombin less than 40% and an NH3 over 100µg/L were significantly related to mortality. Conclusion: The most common clinical manifestations were jaundice, edema and skin bleeding. Subclinical data was recorded following decreasing of prothrombin, albumin and increasing of NH3. Therein, NH3 and prothrombin were related factors for mortality.

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