双重血浆分子吸附系统不同治疗时间的有效性与安全性研究

Study on the efficacy and safety of double plasma molecular adsorption system in different length of treatment time

目的探讨双重血浆分子吸附系统(duble plasma molecular adsorption system,DPMAS)不同治疗时间的有效性及安全性。方法采用前瞻性队列研究,纳入四川大学华西医院2022年9月—2023年12月接受DPMAS治疗的患者,根据实际治疗时间分为2、3、4 h组,分析不同组别患者治疗前后胆红素下降比例、凝血功能、白蛋白、血小板水平变化及凝血事件发生率。结果共纳入99例肝衰竭患者,136例次治疗。3组治疗前、后胆红素下降比例差异有统计学意义(F=4.607,P=0.012),其中2 h组与4 h组比较有统计学差异(t=-3.296,P=0.001),2 h组与3 h组(t=1.783,P=0.078)、3 h组与4 h组(t=-1.244,P=0.216)比较无统计学差异。3组治疗前后活化部分凝血活酶时间(APTT)变化比例(F=1.994,P=0.369)、白蛋白变化比例(F=2.411,P=0.300)、血小板变化比例(F=3.736,P=0.369)及凝血事件发生率(χ^(2)=0.856,P=0.746)比较差异均无统计学意义。不同时段胆红素下降比例:4 h组内0~2 h为(25.35±5.92)%,2~3 h为(3.29±3.29)%,3~4 h为(1.8±3.99)%;3 h组内0~2 h为(24.02±10.31)%,2~3 h为(3.96±3.91)%。结论本研究验证了DPMAS治疗的有效性及安全性,胆红素清除呈现治疗前2 h最高,随时间延长清除比例逐渐衰减的特点。与治疗2 h组相比,治疗3 h与治疗4 h组治疗前后胆红素下降比例升高,3组在APTT、白蛋白、凝血事件发生率等方面比较无明显差异。建议DPMAS的单次治疗时间应至少保证2 h,可延长至4 h。

Objective To discuss the efficacy and safety of double plasma molecular adsorption system(DPMAS)in the different length of treatment time.Methods This is a prospective cohort study,including patients who received DPMAS treatment in West China Hospital of Sichuan University from September 2022 to December 2023.They were divided into 2h,3h and 4h groups according to the actual treatment time,to analyze changes in the proportion of bilirubin clearance,coagulation function,albumin and platelet levels,and the incidence of coagulation events before and after treatment in different groups of patients.Results A total of 99 patients with liver failure were included,including 136 treatments.Proportion of bilirubin decline before and after treatment:The 2h group was(24.05±8.95)%,the 3h group was(27.98±10.83)%,and the 4h group was(30.44±8.81)%,with statistical differences(F=4.607,P=0.012).There was a statistically significant difference(t=-3.296,P=0.001)in the proportion of bilirubin decrease between the 2h and 4h groups and no statistically significant difference between the 2h and 3h groups(t=1.783,P=0.078),and the 3h and 4h groups(t=-1.244,P=0.216).There were no significant differences in the changes of activated partial thromboplastin time(APTT)(F=1.994,P=0.369),albumin(F=2.411,P=0.300),platelet(F=3.736,P=0.369)and incidence of coagulation events(χ^(2)=0.856,P=0.746)among different treatment time groups.The decrease ratio of bilirubin in different periods:in the 4h group(25.35±5.92)%in 0~2h,(3.29±3.29)%in 2~3h,(1.8±3.99)%in 3~4h,in the 3h group(24.02±10.31)%in 0~2h,and(3.96±3.91)%in 2~3h.Conclusion This study validated the effectiveness and safety of DPMAS treatment.The bilirubin clearance ratio showed the highest trend in the first 2 hours and gradually decreased over time.Compared with the 2-hour treatment group,the proportion of bilirubin decrease before and after treatment was significantly increased in the 3-hour and 4-hour treatment groups.At the same time,there were no significant differences in APTT,albumin,and coagulation event incidence among the groups.Therefore,this study suggests that the single treatment time of DPMAS should be guaranteed to be at least 2h,and can be extended to 4h.