三种人工肝模式治疗慢加急性肝衰竭的短期疗效对比分析

Comparative analysis of short-term efficacy of three artificial liver models in the treatment of acute-on-chronic liver failure

目的探讨三种人工肝模式治疗慢加急性肝衰竭(ACLF)的短期疗效,为血浆用量不足情况下治疗模式的选择提供参考。方法选取2018年1月至2021年4月在广西医科大学第四附属医院住院治疗的121例乙型肝炎病毒相关ACLF患者,根据治疗方式分为血浆置换(PE)组(37例)、PE+双重血浆分子吸附(DPMAS)组(62例)、选择性血浆置换(FPE)+DPMAS组(22例)。对3组临床疗效及相关指标等进行比较。结果3组治疗前临床指标[除谷草转氨酶(AST)、凝血酶原时间外]比较,差异无统计学意义(P>0.05)。3组治疗后谷丙转氨酶、AST、总胆红素、总胆汁酸、胆碱酯酶、活化部分凝血活酶时间、血小板计数及终末期肝病模型(MELD)评分等指标与治疗前比较,差异有统计学意义(P<0.05)。FPE+DPMAS组治疗后清蛋白水平与治疗前比较,差异有统计学意义(P<0.05)。3组临床疗效、不良反应发生情况及MELD评分改善情况比较,差异无统计学意义(P>0.05)。结论FPE+DPMAS模式的临床疗效与其他2种模式相当,同时可降低血浆用量,特别适合在血浆用量不足的情况下给有需要的患者进行人工肝治疗。

Objective To explore the short-term efficacy of three artificial liver models in the treatment of acute-on-chronic liver failure(ACLF),so as to provide reference for the selection of treatment modes in the case of insufficient plasma consumption.Methods A total of 121 patients with hepatitis B virus related ACLF hospitalized in the Fourth Affiliated Hospital of Guangxi Medical University from January 2018 to April 2021 were selected and divided into the plasma exchange(PE)group(37 cases),the PE+double plasma molecular adsorption(DPMAS)group(62 cases)and the selective plasma exchange(FPE)+DPMAS group(22 cases)according to the treatment methods.The clinical efficacy and related indexes of the three groups were com-pared.Results There were no significant differences among the three groups in clinical indexes[except for as-partate aminotransferase(AST)and prothrombin time]before treatment(P>0.05).After treatment,the three groups of alanine aminotransferase,AST,total bilirubin,total bile acid,cholinesterase,activated partial thromboplastin time,platelet count and model of end-stage liver disease(MELD)score in the three groups were significantly different from those before treatment(P<0.05).The albumin(ALB)level in the FPE+DPMAS group after treatment was significantly higher than that before treatment(P<0.05).There were no significant differences in clinical efficacy,adverse reactions and MELD scores among the three groups(P>0.05).Conclusion The clinical efficacy of FPE+DPMAS mode is equivalent to that of the other two modes.At the same time,it can reduce the dosage of plasma.It is especially suitable for artificial liver treatment for patients in need when the dosage of plasma insufficient.