不同吸附剂在双重血浆分子吸附系统治疗肝衰竭中的临床研究

Clinical study of different adsorbents with dual plasma molecular adsorption system in the treatment of hepatic failure

目的探讨双重血浆分子吸附系统(DPMARS)治疗肝衰竭中不同吸附剂(活性炭与吸附树脂)组合的疗效对比。方法回顾性分析2016年6月至2018年5月郑州市第六人民医院住院的152例肝衰竭患者,分为DPMARS碳罐组77例、DPMARS树脂组75例。比较两组患者治疗前、治疗后的肝功能、凝血酶原活动度(PTA)、血白蛋白、肿瘤坏死因子α(TNFα)、白细胞介素6(IL-6)等指标的变化。两组间比较采用两独立样本t检验,疗效比较用χ^2检验。结果治疗后两组患者临床症状均有不同程度的改善,碳罐组好转率为89.6%(69/77),树脂组好转率为90.7%(68/75),差异无统计学意义(χ^2=0.048,P=0.975);两组间不良反应率比较,差异无统计学意义(χ^2=0.235,P=0.995)。与治疗前比较,治疗后碳罐组和树脂组总胆红素(t值分别为3.735,3.728,P值均<0.001)、丙氨酸氨基转移酶(t值分别为5.117、5.203,P值均<0.001)、TNFα(t值分别为3.158、3.094,P值均<0.05)、IL-6(t值分别为3.647、3.559,P值均<0.05)均显著降低,差异有统计学意义。而白蛋白、PTA治疗前后比较,P值均>0.05,差异无统计学意义。结论双重血浆分子吸附系统治疗肝衰竭有效,碳罐或者树脂罐均可与特异性胆红素吸附柱组合成DPMARS应用于临床,且二者疗效差异无统计学意义。

Objective To investigate the effects of two different sorbents(Carbon perfusion apparatus and Resin perfusion apparatus)in Double plasma molecular absorb syetem for liver failure treatment. Methods A total of 152 cases with liver failure who were admitted to The Sixth People's Hospital of Zhengzhou, from June 2016 to May 2018 were selected and divided into DPMARS Carbon group (77 cases) and Resin group (75 cases). The two groups were observed in terms of liver function, prothrombin activity(PTA),Plasma albumin ,tumor necrosis factor alpha and interleukin-6 were detected and compared between the two groups before and after treatment. Results ①The clinical symptoms improved in different degree in two groups, the recovery rate of Carbon cans Carbon perfusion apparatus group and Resin group separately were89.6% (69/77)、90.7% (68/75)(χ^2= 0.048, P = 0.975), there were no statistical differences. There were no statistical differences between the two groups in untoward reactions(χ^2= 0.235, P = 0.995), ②Compared with before treatment, TBil(t = 3.735, 3.728;P = 0.000, 0.000)、ALT(t = 5.117, 5.203;P = 0.000, 0.000)、TNF-α (t = 3.158, 3.094;P = 0.000, 0.002)、IL-6(t = 3.647, 3.559;P = 0.002, 0.003)decreased and ALB (t = 2.300, 3.065;P = 0.024, 0.003) increased significantly after treatment in both groups, and there were statistical differences. There were no signifiant differences in the changes in ALB(t = 0.316, 0.209;P = 0.657, 0.720) and PTA(t = 0.810, 0.843;P = 0.429, 0.516). ③After treatment, there were no signifiant differences in the changes in TBil、ALT、ALB、PTA、TNF-α、IL-6(t = 0.377、0.904、-1.133、-1.552、0.841、0.401;P = 0.952、0.283、0.826、0.094、0.154、0.457). Conclusion Double plasma molecular absorb syetem is effective in treating liver failure. Carbon perfusion apparatus or Resin perfusion apparatus can be combined with Specific bilirubin adsorption column for DPMARS in clinical treatment,and their effects are similar.