Effectiveness of plasma exchange plus joint anti-viral treatment on chronic severe hepatitis B

Objective To observe the effectiveness of plasma exchange(PE) plus joint anti-viral drugs,lamivudine and adefovir on the treatment of chronic severe hepatitis B.Methods A total of 137 patients with chronic severe hepatitis B were divided into four groups.And 36 patients in the control group(group A) received a conventional therapy;32 patients(group B) received anti-viral treatment using lamivudine(LAM)(100 mg/d)and adefovir(ADV)(10 mg/d);31 patients in plasma exchange(PE) group(group C) received PE;38 patients in joint treatment group(group D) received PE and anti-viral therapy(drug and dosage was the same as group B).The clinical effect,liver function,prothrombin time,and serum HBV-DNA quantification were observed before and after treatment.Results The rates of clinical improvement of groups A,B,C and D were 33.3%(12/36),46.9%(15/32),64.5%(20/31),and 71.1%(27/38),respectively.The average time required for the clinical improvement was(138±25)d,(105±21) d,(89±18) d and(71±15) d for groups A,B,C,and D,respectively,and there were significant differences among the four groups(P0.01).One month after the treatment,the negative conversion rates of HBV-DNA of the four groups were 0(0/36),59.3%(19/32),0(0/31) and 60.5%(23/38),respectively,and there were significant differences(P0.01) between groups B or D and groups A or C.Three months after the treatment,the negative conversion rates of HBV-DNA of the four groups were 0(0/36),87.5%(28/32),3.2%(1/31) and 92.1%(35/38),respectively,and there were significant differences(P0.01) between groups B or D and groups A or C.The survival rates were 25.0%,36.1%,48.3% and 65.7%,respectively,after one year.After 12 months,the mortality rates in patients with clinical improvement were 25.0%(3/12),6.7%(1/15),25.0%(5/20) and 7.4%(2/27),respectively for groups A,B,C,and D,and there were significant differences(P0.05) between groups B or D and groups A or C.Conclusion The combination of anti-viral medicine and PE can improve liver function and also inhibit viral replication,which could improve patients' long-term survival.