双重血浆分子吸附系统在儿童急性肝衰竭中的应用

Application of double plasma molecular adsorption system in children with acute liver failure

目的探讨双重血浆分子吸附系统(DPMAS)用于儿童急性肝衰竭(PALF)的有效性及安全性。方法前瞻性收集2018年3月至2020年6月在湖南省儿童医院重症医学科住院的PALF患儿的临床资料,随机分为血浆置换组(PE组)和DPMAS组,每组各18例。比较两组患儿临床指标、治疗前后实验室指标和不良反应。结果DPMAS组人工肝次数、ICU住院时间均小于PE组(P<0.05),两组12周生存率比较差异无统计学意义(P>0.05)。两组治疗前实验室指标比较差异无统计学意义(P>0.05)。两组治疗后总胆红素、白细胞介素-6、肿瘤坏死因子-α较治疗前均下降,DPMAS组下降更显著(P<0.05);两组治疗后丙氨酸氨基转移酶较治疗前均下降(P<0.05),但组间差异无统计学意义(P>0.05);PE组治疗后白蛋白较治疗前上升,而DPMAS组较治疗前降低(P<0.05);PE组治疗后凝血酶原时间较治疗前缩短,而DPMAS组较治疗前延长(P<0.05)。两组治疗后总胆红素反弹率差异无统计学意义(P>0.05)。两组间不良反应总发生率差异无统计学意义(P>0.05)。结论DPMAS治疗PALF有效且安全,可作为PALF人工肝治疗时的备选新模式。

Objective To study the efficacy and safety of double plasma molecular absorption system(DPMAS)in the treatment of pediatric acute liver failure(PALF).Methods A prospective analysis was performed on the medical data of children with PALF who were hospitalized in the Intensive Care Unit(ICU),Hunan Children's Hospital,from March 2018 to June 2020.The children were randomly divided into two groups:plasma exchange group(PE group)and DPMAS group(n=18 each).The two groups were compared in terms of clinical indices after treatment,laboratory markers before and after treatment,and adverse events after treatment.Results Compared with the PE group,the DPMAS group had a significantly lower number of times of artificial liver support therapy and a significantly shorter duration of ICU stay(P<0.05),while there was no significant difference in the 12-week survival rate between the two groups(P>0.05).There was no significant difference in laboratory markers between the two groups before treatment(P>0.05).After treatment,both groups had reductions in the levels of total bilirubin,interleukin-6,and tumor necrosis factor-α,and the DPMAS group had significantly greater reductions than the PE group(P<0.05).Both groups had a significant reduction in alanine aminotransferase(P<0.05),while there was no significant difference between the two groups(P>0.05).The PE group had a significant increase in albumin,while the DPMAS group had a significant reduction in albumin(P<0.05).The PE group had a significant reduction in prothrombin time,while the DPMAS group had a significant increase in prothrombin time(P<0.05).There was no significant difference between the two groups in the rebound rate of total bilirubin and the overall incidence rate of adverse events after treatment(P>0.05).Conclusions DPMAS is safe and effective in the treatment of PALF and can thus be used as an alternative to artificial liver support therapy.