不同模式血液净化技术治疗肝功能衰竭的疗效观察

Therapeutic efficacy of different models of blood purification technology for liver failure

目的探讨不同模式血液净化技术对肝功能衰竭患者疗效的评价。方法选取华中科技大学同济医学院附属同济医院接受血液净化治疗的肝功能衰竭患者,包括血浆置换(plasma exchange, PE)、PE+胆红素吸附及PE+双重血浆分子吸附(double plasma molecular adsorption system, DPMAS)3种模式,比较各组患者治疗前后总胆红素(total bilirubin, TBil)、直接胆红素、肝功能、肾功能、血红蛋白、血小板计数、凝血酶原时间(prothrombin time, PT)、活化部分凝血酶原时间(activated partial thromboplastin time, APTT)、国际标准化比值(international normalized ratio, INR)及终末期肝病模型(MELD)评分等的变化,比较各组之间的疗效,同时比较在不同模式下血浆及人血白蛋白用量对疗效的影响。结果 (1)治疗前后对比,在PE+DPMAS组,患者TBil、直接胆红素、天冬氨酸转氨酶(glutamic-oxaloacetic transaminase, GOT)、丙氨酸转氨酶(glutamic-pyruvic transaminase, GPT)、碱性磷酸酶、总蛋白、乳酸脱氢酶、尿素氮、血肌酐、血红蛋白、MELD评分明显降低、PT、APTT、INR明显增加,差异有统计学意义(P<0.05);在PE+胆红素吸附组,患者TBil、直接胆红素明显降低、白蛋白明显增加,差异有统计学意义(P<0.05);PE组患者TBil、直接胆红素治疗后有下降趋势;(2)3组模式组间比较,PE+DPMAS组TBil、直接胆红素、GOT、GPT、碱性磷酸酶、APPT、MELD评分下降更加明显、差异有统计学意义(P<0.05);(3)PE+胆红素吸附组补充白蛋白量和胆红素下降率呈负相关(r=-0.34,P=0.02),具有统计学意义。结论 3种不同血液净化模式均可不同程度改善患者肝功能;3种模式比较,PE+DPMAS组在改善肝功能方面高于PE组和PE+胆红素吸附组;PE+胆红素吸附组治疗过程中,患者补充白蛋白越多,胆红素下降越明显。

Objective To evaluate the therapeutic efficacy of liver failure patients with blood purification technology under different modes.Methods All patients of liver failure received blood purification,including separate plasma exchange(PE),PE+bilirubin adsorption and PE+double plasma molecular adsorption system(DPMAS).Clinical data were collected for selected candidates.The counts of total bilirubin,direct bilirubin,liver function,kidney function,hemoglobin and platelets before and after treatment were recorded.And the levels of prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR)score changes of model for end-stage liver disease(MELD)and efficacies of three groups were also compared.Moreover,the effects of human plasma and albumin dosage were evaluated.Results The clinical data of each group before and after treatment were compared.In PE+DPMAS group,total bilirubin,direct bilirubin,aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,total protein,lactate dehydrogenase,urea nitrogen,creatinine,hemoglobin and MELD scores declined markedly while PT,APTT and INR spiked with statistical significance(P<0.05).In PE+bilirubin adsorption group,total bilirubin and direct bilirubin declined markedly and albumin became elevated(P<0.05).In PE group,total bilirubin and direct bilirubin showed a declining trend.When three groups were compared with each other,total bilirubin,direct bilirubin,aspartate aminotransferase,aspartate aminotransferase,alkaline phosphatase,APPT and MELD scores decreased markedly in PE+DPMAS group and there was statistical significance(P<0.05).The amount of albumin supplementation in PE+bilirubin adsorption group was negatively correlated with lower bilirubin(r=-0.34,P=0.02).And there was statistical significance.Conclusion Three blood purification modes may improve liver function in different degrees.In PE+DPMAS group,the efficiency of lowering bilirubin was higher than that in PE or PE+bilirubin adsorption group.The more albumin supplemented in PE+bilirubin adsorption group during treatment,the greater reduction in bilirubin.