血浆置换联合双重血浆分子吸附系统序贯治疗终末期肝病肝功能衰竭的临床观察

Clinical observation of PE combined with DPMAS sequential treatment of liver failure in end-stage liver disease

目的比较慢加急性肝衰竭(ACLF)患者应用双重血浆分子吸附系统(DPMAS)、血浆置换(PE)和PE+DPMAS的非生物型人工肝(NBAL)3种治疗方法的疗效。方法回顾性地收集了2018年11月至2021年12月在天津市第一中心医院接受NBAL治疗的ACLF患者80例,分为PE组(29例)、DPMAS组(25例)和PE+DPMAS组(26例),观察和比较3组患者治疗有效率、28 d生存率以及治疗前后体征和临床症状水平,并对治疗前后患者的血常规、凝血功能、肝肾功能、总胆红素清除率和炎症指数等临床指标进行检测;比较3组患者的终末期肝病模型(MELD)评分、全身炎症反应综合征(SIRS)评分,全身性感染相关性器官功能衰竭(SOFA)评分、Child-Pugh肝功能分级以及治疗前后慢性肝炎分期。结果在早期ACLF患者中,PE组、DPMAS组和PE+DPMAS组治疗有效率和28 d生存率均分别为54.5%、50.0%、84.6%,PE+DPMAS组与其他两组相比临床疗效显著,28 d生存率显著提高(P<0.05)。PE组和PE+DPMAS组患者治疗后凝血酶原时间较治疗前不同程度地减少[(13.3±3.8)s vs(22.8±6.6)s,(15.9±4.5)s vs(22.0±6.4)s],凝血酶原前体蛋白值较治疗前显著增加[(58.2±13.3)mg/L vs(46.8±10.8)mg/L,(54.3±17.7)mg/L vs(44.4±10.3)mg/L],差异有统计学意义(P<0.05)。治疗后3组患者白细胞计数增加、血小板计数减少,MELD评分、SIRS评分、SOFA评分、Child-Pugh分级均有所下降,差异有统计学意义(P<0.05)。结论PE、DPMAS和PE+DPMAS对ACLF患者各项指标均有改善作用。给予PE+DPMAS治疗后28 d生存率在早期ACLF患者中有显著提高。

Objective To compare the efficacy of three non-biological artificial liver(NBAL)treatments in patients with slow-onset acute liver failure(ACLF):double plasma molecular absorption system(DPMAS),plasma exchange(PE),and PE+DPMAS.Methods Eighty patients with ACLF treated with NBAL in Tianjin First Central Hospital from November 2018 to December 2021 were retrospectively collected and divided into PE group(29 patients),DPMAS group(25 patients),and PE+DPMAS group(26 patients).The patients efficacy rate,28-day survival rate,and levels of signs and clinical symptoms before and after treatment were observed and compared.Clinical indicators such as blood routine,coagulation function,liver and kidney function,total bilirubin clearance rate,and inflammation index were tested before and after treatment.The Model for End-Stage Liver Disease(MELD)score,Systemic Inflammatory Response Syndrome(SIRS)score,Sepsis-Related Organ Failure Assessment(SOFA)score,Child-Pugh liver function classification,and chronic hepatitis staging before and after treatment were compared among the three groups.Results In patients with early ACLF,the efficacy rates after treatment were 54.5%,50.0%,and 84.6%in PE,DPMAS,and PE+DPMAS group,respectively.The PE+DPMAS group had significant clinical efficacy compared with the other two groups,and its 28-day survival rate significantly improved(P<0.05).Patients in PE and PE+DPMAS group showed varying degrees of reduction in prothrombin time after treatment compared with those before treatment[(13.3±3.8)s vs(22.8±6.6)s,(15.9±4.5)s vs(22.0±6.4)s],and significant increase in prothrombin precursor protein values compared with that before treatment[(58.2±13.3)mg/L vs(46.8±10.8)mg/L,(54.3±17.7)mg/L vs(44.4±10.3)mg/L],with statistically significant differences(P<0.05).There was an increase in white blood cell count,platelet count,and a decrease in MELD score,SIRS score,SOFA score,and Child-Pugh classification in three groups after treatment,with statistically significant differences(P<0.05).Conclusion PE,DPMAS,and PE+DPMAS showed improvement in all indicators in patients with ACLF.The 28-day survival rate after PE+DPMAS treatment significantly improved in patients with early ACLF.