目的　探讨白蛋白置换治疗难治性肝炎高胆红素血症的疗效和作用机理。方法　 84例病人随机分成治疗组 5 3例 ,对照组 31例。基本治疗给予强力宁 ;对照组在基本治疗基础上给予复方丹参 (或茵栀黄 )。治疗组在基本治疗基础上采用血液成分分离机 ,分离和去除部分含有胆红素等有害物质的血浆 ,回输血液有形成分 ,平均每次置换 30 0～ 40 0ml血浆 ,同时补充 30g白蛋白 ;每周置换 2次 ,4次为一疗程。结果　治疗组总有效率为 86 .8% ,高于对照组的 6 7.7% (P <0 .0 5 ) ,其中显效率 (4 3.4% )明显优于对照组 (19.4% ) (P <0 .0 5 ) ;急性肝炎治疗组的总有效率 (96 .7% )高于对照组 (78.6 % ) (P <0 .0 5 ) ,显效率 (6 3.3% )明显高于对照组 (2 8.6 % )(P <0 .0 5 )。在急、慢性肝炎治疗有效的病人中 ,治疗组每日SB下降均值 [分别为 (8.44± 7.2 2 )和 (4 .94±2 .5 9) μmol/L]幅度明显较对照组 [分别为 (3.0 4± 1.6 7)和 (1.6 9± 0 .72 ) μmol/L]增高 (分别为P <0 .0 5和P <0 .0 0 5 ) ;住院天数 [分别为 (5 4± 30 )和 (6 5± 2 4)d]则显著少于对照组 [分别为 (79± 14)和 (89± 2 1)d](P <0 .0 5 )。部分急、慢性肝炎病人治疗后CD4/CD8值明显上升 (P <0 .0 5和P <0 .0 1) ,IL 2上升 (P <0 .0 5 ) ,sIL 2R Objective To investigate the therapeutic effect and mechanism of albumin replacement on refractory hepatitis with hyperbilirubinemia. Methods 84 patients were randomly divided into treatment group 53 cases, control group 31 cases. The basic treatment given strong Ning; control group on the basis of the basic treatment given compound Salvia (or Yinzhihuang). Treatment group based on the basic treatment using blood component separator, separation and removal of some of the plasma containing bilirubin and other harmful substances, transfusion of blood visible components, the average per replacement 30 0 ~ 40 0ml plasma, supplemented with 30g albumin ; 2 times a week replacement, 4 times for a course of treatment. Results The total effective rate in the treatment group was 86.8%, which was significantly higher than that in the control group (7.7%, P <0.05), and the effective rate (4.34%) in the treatment group was significantly better than that in the control group (19.4%) (P0.05). The total effective rate (96.7%) in acute hepatitis group was significantly higher than that in control group (78.6%) (P0.05) 8.6%) (P <0.05). In the patients with acute and chronic hepatitis treatment, the daily mean SB decreased (8.44 ± 7.22 and (4.94 ± 2.59) μmol / L, respectively) in the treatment group compared with the control group [ (3.0 4 ± 1.6 7) and (1.6 9 ± 0.72) μmol / L, respectively, P <0.05 and P <0.05, respectively; ) And (65 ± 2 4) d] were significantly less than those in the control group [(79 ± 14) and (89 ± 21) d], respectively (P <0.05). The CD4 / CD8 of some acute and chronic hepatitis patients significantly increased (P <0.05 and P <0.01), IL 2 increased (P <0.05), sIL 2R