血浆置换联合连续性血液净化对儿童急性肝衰竭血浆S100β及mtDNA的影响

Effects of plasma exchange combined with continuous blood purification on the expression of plasma S1OoB and mtDNA in children with acute liver failure

目的探讨血浆置换联合连续性血液净化治疗儿童急性肝衰竭的疗效及对血浆S100β蛋白、线粒体DNA(mtDNA)表达变化的影响。方法收集湖南省儿童医院2018年1月至2022年10月收治的31例采用常规内科综合治疗基础上加用血浆置换联合连续性血液净化治疗的急性肝衰竭患儿的临床资料,分析急性肝衰竭患儿病因、合并症、不良反应、转归及终末期肝病模型(MELD)评分等,比较治疗前后肝肾功能、凝血功能、S100β、mtDNA的变化及S100β、mtDNA与MELD评分的相关性。结果治疗后总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血氨(NH3)、总胆汁酸(TBA)、尿素氮(BUN)、肌酐(Cr)水平均呈下降趋势,治疗后第3天各指标均低于治疗前,治疗后第7天各指标均低于治疗前和第3天,差异有统计学意义(P<0.05)。治疗后凝血功能相关指标国际标准化比值(INR)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)水平均呈下降趋势,治疗后第3天INR、PT均低于治疗前,治疗后第7天各指标均低于治疗前和第3天,其差异均具有统计学意义(P<0.05)。入院时MELD评分为(23.50±4.71)分,治疗前S100β、mtDNA水平与MELD评分均呈正相关(r=0.268、P=0.000;r=0.297、P=0.000)。治疗后S100β、mtDNA水平均呈下降趋势,治疗后第3天S100β、mtDNA均低于治疗前,治疗后第7天S100β、mtDNA均低于治疗前和第3天,其差异均具有统计学意义(P<0.05)。结论S100β与mtDNA在急性肝衰竭患儿中显著升高,其水平可能与肝衰竭严重程度相关。血浆置换联合连续性血液净化能有效降低S100β和mtDNA水平,改善急性肝衰竭患儿预后。

Objective To investigate the effect of plasma exchange combined with continuous blood purification on children with acute liver failure and its effect on plasma S10oβprotein and mitochondrialDNA(mtDNA).Methods The clinical data of 31 children with acute liver failure from January 2018 to October 2022 who were treated with plasma exchange combined with continuous blood purification on the basis of general medical treatment in Hunan Children's Hospital were analyzed.Children's etiology,comorbidities,adverse reactions,outcomes,and end-stage liver disease model(MELD)scores were recorded.Changes in liver and kidney function,coagulation function,S10op,mtDNA,and the correlation between S100p,mtDNA,and MELD scores before and after treatment were compared.Results After treatment,total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood ammonia(NH3),total bile acid(TBA),and urea nitrogen(BUN)The levels of creatinine(Cr)showed a downward trend.All indicators on day 3 after treatment were lower than before treatment,and all indicators on day 7 after treatment were lower than before and 3 days.The differences were statistically significant(P<0.05).After treatment,the international standardized ratio(INR),prothrombin time(PT),and activated partial prothrombin time(APTT)levels of the relevant indicators of blood coagulation function showed a downward trend.The INR and PT on the third day after treatment were lower than before treatment.All indicators on day 7 after treatment were lower than before treatment and on day 3,and the differences were statistically significant(P<0.05).The MELD score at admission was(23.50±4.71)points,and the levels of S100βand mtDNA before treatment were positively correlated with the MELD score(r=0.268,P=0.000;r=0.297,P=0.000).After treatment,the levels of S100g and mtDNA showed a downward trend.On the third day after treatment,S10op and mtDNA were lower than before treatment,and on the seventh day after treatment,S100βand mtDNA were lower than before and on the third day.The differences were statistically significant(P<0.05).Conclusions S100βand mtDNA were significantly increased in children with acute liver failure,and the levels may be related to the severity of liver failure.Plasma exchange combined with continuous blood purification could effectively reduce S10oβand mtDNA levels and improve the prognosis of children with acute liver failure.