Objective To investigate the clinical effect of plasma exchange( PE) combined with hemofiltration( HF) in the treatment of subacute liver failure( SALF) induced by antitubercular agents. Methods A total of 58 patients with SALF induced by antitubercular agents who visited Henan Provincial People's Hospital from July 2009 to January 2015 were collected and divided into PE treatment group( 27patients) and PE- HF combined treatment group( 31 patients) according to different therapeutic methods. The changes in clinical symptoms and signs,liver function,renal function,electrolytes,and coagulation function after treatment were investigated and compared between the two groups,and the incidence of adverse events and 6- month survival rate were observed in both groups. The t- test was applied for comparison of continuous data between groups,and the chi- square test was applied for comparison of categorical data between groups. Results After treatment,both PE treatment group and PE- HF combined treatment group had significant reductions in the levels of ALT,AST,TBil,GGT,and ALP,as well as a significant increase in prothrombin activity( PTA)( t = 2. 871,2. 986,2. 905,2. 063,4. 028,- 2. 591,2. 940,2. 935,2. 940,2. 918,4. 981,and- 2. 933,all P < 0. 05); the PE- HF combined treatment group had significantly greater reductions in ALT,AST,TBil,GGT,and ALP and a significantly greater increase in PTA,as compared with the PE treatment group( t =- 2. 891,-2. 784,- 2. 194,- 3. 014,- 0. 294,and- 3. 907,all P < 0. 05). In the PE treatment group,the response rates to correct high urea( UREA),high creatinine( Cr),hypokalemia,hyponatremia,hypochloridemia,and hypocalcemia were 80. 00%,60. 00%,81. 82%,78. 57%,88. 89%,and 75. 00%,respectively; in the PE- HF combined treatment group,these response rates were 85. 71%,87. 50%,85. 71%,92. 31%,92. 31%,and 86. 67%,respectively; there were significant differences in these response rates between the two groups( χ2= 9. 603,11. 302,9. 543,13. 987,9. 493,and 9. 502,all P < 0. 05). The PE treatment group had an overall response rate of88. 89% and a mean hospital stay of 36. 36 days,while the PE- HF combined treatment group had an overall response rate of 96. 77% and a mean hospital stay of 26. 03 days; the incidence rates of adverse events in these two groups were 5. 06% and 7. 06%,respectively. Conclusion As for the treatment of SALF induced by antitubercular agents,compared with PE treatment alone,PE combined with HF can significantly relieve patients' clinical symptoms and signs,improve liver function,correct electrolyte disturbance,improve renal function,increase overall response rate,and reduce the mean hospital stay,and has a lower incidence rate of adverse events. Therefore,it is an effective and safe therapeutic method.
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