双重血浆分子吸附系统联合激素治疗慢加急性肝衰竭的疗效

Effects of double plasma molecular adsorption system combined with glucocorticoids therapy on acute-on-chronic liver failure

目的探讨双重血浆分子吸附系统(DPMAS)联合糖皮质激素治疗乙型肝炎病毒(HBV)感染相关的慢加急性肝衰竭患者的临床疗效。方法收集2016年1月至2019年2月第九〇一医院感染科接受DPMAS治疗好转出院的38例HBV相关慢加急性肝衰竭患者的临床资料,根据治疗方法不同分为观察组(n=20,DPMAS联合糖皮质激素治疗)和对照组(n=18,DPMAS治疗)。记录所有患者临床表现、肝功能、凝血功能、炎症指标、住院时间、DPMAS治疗次数等。结果(1)治疗2周时,观察组患者总胆红素(TBIL)、C反应蛋白(CRP)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)改善情况均好于对照组,差异均有统计学意义(t值分别为4.572、6.625、2.416、3.026,P值分别为<0.001、<0.001、0.024、0.005);(2)治疗2周时观察组患者TBIL、CRP、IL-6、IL-8的下降率明显高于对照组,差异有统计学意义(t值分别为-5.850、-2.241、-3.917、-2.147,P值分别为<0.001、0.031、<0.001、0.039);(3)观察组与对照组消化道症状改善时间[(3.20±1.15)d vs.(10.11±2.49)d,P<0.001]、TBIL降至肝衰竭诊断临界值之下的时间[(15.25±1.33)d vs.(19.92±2.81)d,P<0.001]、住院时间[(44.20±4.62)d vs.(59.25±8.06)d,P<0.001]、DPMAS治疗次数[(3.00±0.97)次vs.(4.22±1.52)次,P=0.007]差异均有统计学意义;(4)观察组与对照组肺部感染发生率(15.0%vs.22.2%,P=0.566)、自发性细菌性腹膜炎发生率(40.0%vs.33.8%,P=0.671)、腹水发生率(45.0%vs.44.4%,P=0.973)、肝肾综合征发生率(10.0%vs.16.7%,P=0.544)差异均无统计学意义。结论DPMAS联合糖皮质激素在治疗前期可快速降低HBV相关慢加急性肝衰竭患者血清TBIL及炎症因子水平,缓解患者消化道症状,减少平均住院时间及DPMAS治疗次数,加速患者病情恢复,且对并发症无明显影响,值得临床进一步探究。

Objective To investigate the clinical efficacy of double plasma molecular adsorption system(DPMAS)combined with glucocorticoids therapy in patients with HBV-related acute-on-chronic liver failure.Methods A total of 38 patients with HBV-related acute-on-chronic liver failure who were treated with DPMAS and discharged from the Department of Infectious Diseases of the 901th Hospital from January 2016 to February 2019 were collected and divided into observation groups(n=20,DPMAS combined with glucocorticoid treatment)and control group(n=18,DPMAS treatment).The clinical manifestations,liver function,coagulation function,inflammation index,length of hospital stay,and frequency of DPMAS treatment were recorded.Results(1)At 2 weeks of treatment,the observation group showed significantly better improvements in the total bilirubin,C reactive protein,interleukin-6 and interleukin-8 compared with the control group(t=4.572,P=0.000;t=6.625,P=0.000;t=2.416,P=0.024;t=3.026,P=0.005,respectively).(2)At 2 weeks of treatment,the observation group showed significantly higher improvements in the decrease rate of total bilirubin,C reactive protein,interleu-kin-6 and interleukin-8 compared with the control group(t=-5.850,P=0.000;t=-2.241,P=0.031;t=-3.917,P=0.000;t=-2.147,P=0.039,respectively).(3)the improvement of gastrointestinal symptoms took[(3.20±1.15)d and(10.11±2.49)d,P=0.000],the total bilirubin to fall below the diagnostic threshold for liver failure took[(15.25±1.33)d and(19.92±2.81)d,P=0.000],the length of hospital stay[(44.20±4.62)d and(59.25±8.06)d,P=0.000],and the number of DPMAS treatments were[(3.00±0.97)time and(4.22±1.52)time,P=0.007],respectively in the two groups.(4)The occurrences of pulmonary infection in observation and control groups were 15.0%and 22.2%,respectively(P=0.566);the occurrences of spontaneous bacterial peritonitis in observation and control groups were 40.0%and 33.8%,respectively(P=0.671);the occurrences of ascites in observation and control groups were 45.0%and 44.4%,respectively(P=0.973);the occurrences of hepatorenal syndrome in observation and control groups were 10.0%and 16.7%,respectively(P=0.544).Conclusion In the treatment of HBV-related acute-on-chronic liver failure,DPMAS combined with glucocorticoid rapidly reduced serum total bilirubin and inflammatory factors,and relieved gastrointestinal symptoms.Meanwhile,it also shortened the length of hospital stay,accelerated the recovery of patients,and had no significant effect on complications.Further research is needed to study its clinical efficacy.