双重血浆分子吸附系统序贯半剂量血浆置换对早中期肝衰竭的疗效分析

Efficacy of dual plasma molecular adsorption system combined with sequential half-dose plasma exchange in the treatment of early and middle stage liver failure

目的了解单纯血浆置换(PE)与双重血浆分子吸附系统(DPMAS)序贯半剂量PE(DPMAS+PE)治疗早中期肝衰竭的短期疗效与长期生存率。方法回顾性收集2020—2021年在山西医科大学第一医院经人工肝治疗的早中期肝衰竭患者(67例),按照不同人工肝治疗模式分为PE组(42例)和DPMAS+PE组(25例),比较治疗后肝功能与凝血指标的变化与4周、48周无肝移植存活率。结果PE组经(2.88±1.35)次,DPMAS+PE组经(3.10±1.01)次人工肝治疗后,PE组TBil总体下降率、DBil总体下降率分别为(38.19±36.36)%和(45.03±29.58)%,均低于DPMAS+PE组(t=-3.83和-3.69,P均<0.001);INR总体下降率为(32.71±22.68)%,高于DPMAS+PE组(t=2.93,P=0.005);治疗后72 h PE组TBil、凝血酶原时间、INR反弹率分别为(44.25±40.74)%、(26.95±29.52)%和(31.02±35.87)%,均高于DPMAS+PE组,差异均有统计学意义(t=2.25、4.43和4.56,P均<0.05)。此外,PE组治疗后4周(χ^(2)=4.72,P=0.030)、48周(χ^(2)=4.32,P=0.038)无肝移植存活率低于DPMAS+PE组。结论DPMAS+PE较单纯PE更能改善肝功能,提高早中期肝衰竭患者的长期生存率,很有可能是早中期肝衰竭患者的一种有效治疗手段。

Objective To understand the short-term efficacy and long-term survival rate of simple plasma exchange(PE)and dual plasma molecular adsorption system with sequential half-dose PE(DPMAS+PE)in the treatment of early and middle stage liver failure.Methods A retrospective analysis was performed on 67 patients with early and middle stage liver failure treated with artificial liver in the First Hospital of Shanxi Medical University from 2020 to 2021.According to the different artificial liver models,they were divided into PE group(42 cases)and DPMAS+PE group(25 cases).The changes of liver function and coagulation index after treatment,and the survival rates without liver transplantation at 4 weeks and 48 weeks were compared.Results After(2.88±1.35)times of artificial liver treatment in PE group and(3.10±1.01)times in DPMAS+PE group,the overall decrease rates of TBil and DBil were(38.19±36.36)%and(45.03±29.58)%in PE group,which were both significantly lower than those in DPMAS+PE group(t=-3.83 and-3.69,P both<0.001).The overall decrease rate of INR in PE group were(32.71±22.68)%,which was significantly higher than that in DPMAS+PE group(t=2.93,P=0.005).The rebound rates of TBil,prothrombin time(PT-S)and INR in PE group at 72 hours after treatment were(44.25±40.74)%,(26.95±29.52)%and(31.02±35.87)%,which were all higher than those in DPMAS+PE group with statistically significant differences(t=2.25,4.43 and 4.56,P all<0.05).In addition,the liver graft-free survival rates at 4 weeks(χ^(2)=4.72,P=0.030)and 48 weeks(χ^(2)=4.32,P=0.038)after treatment in PE group were significantly lower than those in DPMAS+PE group.Conclusions Compared with simple PE,DPMAS+PE can improve liver function and long-term survival rate of patients with early and middle stage liver failure,which is likely to be an effective treatment for patients with early and middle stage liver failure.