| Objective:To discuss the safety of modified plasma exchange combined with umbilical cord-derived mesenchymal stem cells in the treatment of HBV realated acute-on-chronic liver,and to analyze and evaluate its efficacy and clinical valueMethods:Retrospectively analyze the case data of 96 patients with HBV realated acute-on-chronic liver from January 2015 to January 2019 in Ganmei Hospital Affiliated to Kunming Medical University,and group them by strict inclusion criteria,specific grouping and treatment is as follows:48 patients with HBV realated acute-on-chronic liver belong to group A,with it,only conventional medical treatment and modified plasma exchange were used.Another forty-eight patients with HBV realated acute-on-chronic liver belong to group B.Under conventional medical treatment and modified plasma exchange,umbilical cord mesenchymal stem cell transplantation was also performed(iv).We collected the relevant laboratory indicators(TBIL,AST/ALT,ALB,INR,HBV-DNA,AFP,etc.)of each group before treatment,and sorted out the 3td,7thd,1th month,3th month indicators(TBIL、AST/ALT、ALB、INR、HBV-DNA、AFP,etc)、the survival time of 1 year after the treatment.SPSS21.0 software used for statistical analysis.Analyze the short-term and long-term clinical efficacy of each group,and observe the adverse reactions during and after treatment.Analyze and evaluate the safety and clinical efficacy of modified plasma exchange combined with umbilical cord mesenchymal stem cells in the treatment of HBV realated acute-on-chronic liver.Results:The included 96 patients with HBV-ACLF had complications related to different treatments,13 patients with hypotension(8 patients in group A and 5 patients in group B);Allergic reaction,5 cases of urticaria(4 cases in group A,1 case in group B)1 case in group);in the course of treatment,the patient’s symptoms were not relieved,or the symptoms became worse,and the treatment method was changed,that was,(LT)(3 cases in group A,1 case in group B);15 cases with fever(group A 5 cases,10 cases in group B);3 cases of gastrointestinal bleeding(2 cases in group A,1 case in group B);1 case of hepatic encephalopathy,(1 case in group A,0 cases in group B);liver and kidney syndrome(1 case in group A,0 cases in group B),3 cases of secondary SBP(2 cases in group A,1 case in group B);hemorrhage at the site of catheterization(6 cases in group A,3 cases in group B).Allergy,hemostasis,anti-infection,gauze bandage bleeding sites and other symptomatic treatments,All treatments were successfully completed.Before treatment,all the biochemical indicators(TBIL,AST/ALT,ALB,INR,HBV-DNA,AFP,etc.)were not statistically different(P>0.05);following-up 3d,each biochemical indicator(TBIL,AST/ALT,ALB,INR,HBV-DNA)of each group have decreased compared with before(without treatments),but there is no statistical difference between the two groups of A and B(P>0.05).However,from 7thd,1th month,3th month,each biochemical indicator mentioned above There was a statistically significant difference(P<0.05)between A and B groups,as for AFP,following-up 3thd 7thd,1thmonth,3th month,AFP in group A was significantly higher than group B,and there was a significant statistical difference between A and B(P<0.05);By comparing the clinical improvement rate,overall complication,and long-term(after 1 year)survival rate(Log-rank test),we got the conclusion that the short-term improvement rate,safety,and long-term survival rate of group B were better than group A.Conclusion(s):1.On the basis of the use of modified plasma exchange(group A)for HBV-ACLF in the early stage of our center,we continued to explore the therapy of HBV-ACLF patients with improved plasma exchange combined umbilical cord mesenchymal stem cells therapy(group B),At last,we draw an conclusion:The efficacy of group B,Short-term clinical improvement rate,overall complication and long-term survival rate are better than group A,the results are statistically different.This shows that the treatment of HBV-ACLF with improved plasma exchange combined umbilical cord-derived mesenchymal stem cells is a safe and effective method,and it is worthy of further promotion in clinical practice.2.In the course of treatment,AFP can be used as a predictor of short-term clinical efficacy of HBV-ACLF patients.3.On the basis of the use of modified plasma therapy in the early stage(reduce the free HBV-DNA in the serum and avoid secondary attack on the liver),combing with stem cells can accelerate the regeneration of liver cells and promote the recovery of liver function and coagulation function. |
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