[Clinical study of treatment with continuous renal replacement therapy on severe hepatitis with hepatic encephalopathy].

OBJECTIVE: To evaluate clinical significance and the therapeutic mechanisms of the treatment with continuous renal replacement therapy on severe hepatitis with hepatic encephalopathy. METHODS: Forty-seven cases were randomly divided into three groups: continuous renal replacement therapy (CRRT) group, plasma exchange (PE)+CRRT group and basic treatment group. The former two groups were respectively operated by CRRT and PE+CRRT with basic treatment. Serum biochemical tests, amino, tumor necrosis factor-alpha(TNF-alpha) and interleukin-6 (IL-6) were performed before and after treatment with CRRT. RESULTS: 75.0% patients in CRRT group and 86.7% patients in PE+CRRT group regained normal consciousness, but in basic treatment group 31.3%, achieved a normal neurologic recovery (all P<0.05). The survival rate of patients in CRRT group, PE+CRRT group and basic treatment group were respectively 25.0%, 46.7%, 6.25% (all P<0.05). It was showed that renal function and serum amino were markedly improved after treatment with CRRT, serum TNF-alpha and IL-6 decreased (all P<0.05). There were no changes in levels of serum bilirubin and total bile acid. The hemodynamic function was kept stable and there were no complications during the CRRT therapy. The survival rate of patients was associated with the degree of hepatic encephalopathy in CRRT group, PE+CRRT group(P<0.05). CONCLUSION: Our results show that CRRT is an effective mean in treating severe hepatitis with hepatic encephalopathy and obviously increase the survival rate combined with PE in early hepatic encephalopathy.