Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-onchronic liver failure:a nationwide prospective multicenter study in China

BACKGROUND： Plasma exchange （PE）-centered artificial liver support system reduced the high mortality rate of hepa titis B virus （HBV）-related acute-on-chronic liver failure （ACLF）. But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.

Therapeutic plasma exchange in liver failure

The multi-organ failure syndrome associated with acute and acute-on-chronic liver failure(ACLF)is thought to be mediated by overwhelming systemic inflammation triggered by both microbial and non-microbial factors.Therapeutic plasma exchange(TPE)has been proven to be an efficacious therapy in autoimmune conditions and altered immunity,with more recent data supporting its use in the management of liver failure.Few therapies have been shown to improve survival in critically ill patients with liver failure who are not expected to survive until liver transplantation(LT),who are ineligible for LT or who have no access to LT.TPE has been shown to reduce the levels of inflammatory cytokines,modulate adaptive immunity with the potential to lessen the susceptibility to infections,and reduce the levels of albumin-bound and water-bound toxins in liver failure.In patients with acute liver failure,high volume TPE has been shown to reduce the vasopressor requirement and improve survival,particularly in patients not eligible for LT.Standard volume TPE has also been shown to reduce mortality in certain sub-populations of patients with ACLF.TPE may be most favorably employed as a bridge to LT in patients with ACLF.In this review,we discuss the efficacy and technical considerations of TPE in both acute and acute-on-chronic liver failure.

Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy

BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.

Therapeutic plasma exchange and a double plasma molecular absorption system in the treatment of thyroid storm with severe liver injury: A case report

BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means.Plasma exchange(PE)and double plasma molecular absorption system(DPMAS)can be used as an effective treatment for thyroid storm with severe liver injury.CASE SUMMARY A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa.Further,her free T3(FT3)and FT4 levels were significantly elevated,whereas her thyrotropin level was reduced.After admission,her condition continued to deteriorate,and she presented with continued high fever,vomiting,palpitation,and shortness of breath.After being diagnosed with thyroid storm,the patient was immediately treated with PE combined with DPMAS.Her symptoms improved immediately.After three PE+DPMAS treatments,and she was discharged from the hospital.She was treated with methylprednisolone and methylthimidazole.After six months,the patient spontaneously discontinued methylthimidazole treatment.Her previous clinical manifestations and liver dysfunction reoccurred.The patient was treated with PE+DPMAS two times,and her condition rapidly improved.Liver histopathology indicated immunological liver injury.CONCLUSION Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.

The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation

Background:The shortage of donor liver restricts liver transplantation(LT).Nowadays,donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver.Although it is now possible to perform ABO-incompatible(ABO-I)LT,antibody-mediated rejection(AMR)has been recognized as the primary cause of desperate outcomes after ABO-I LT.Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury.Therapeutic plasma ex-change(TPE)can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sources:We searched PubMed and CNKI databases using search terms“therapeutic plasma ex-change”,“ABO-incompatible liver transplantation”,“ABO-I LT”,“liver transplantation”,“LT”,“antibody-mediated rejection”,and“AMR”.Additional publications were identified by a manual search of references from key articles.The relevant publications published before September 30,2020 were included in this review.Results:Different centers have made different attempts on whether to use TPE,when to use TPE and how often to use TPE.However,the control standard of lectin revision level is always controversial,the target titer varies significantly from center to center,and the standard target titer has not yet been estab-lished.TPE has several schemes to reduce antibody titers,but there is a lack of clinical trials that provide standardized procedures.Conclusions:TPE is essential for ABO-I LT.Hence,further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.

The MELD scoring system for predicting prognosis in patients with severe hepatitis after plasma exchange treatment

BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.

Early plasma exchange and continuous renal replacement therapy improve puerperal prognosis in hepatitis B virus-related acute-on-chronic liver failure in pregnancy

Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF.Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE.Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006).Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.

Comparison between bioartificial and artificial liver for the treatment of acute liver failure in pigs

AIM: To characterize and evaluate the therapeuti efficacy of bioartificial liver (BAL) as compared to tha of continuous hemodiafiltration (CHDF) with plasma exchange (PE), which is the current standard therapy fo fulminant hepatic failure (FHF) in Japan. METHODS: Pigs with hepatic devascularization were divided into three groups: (1) a non-treatment group (NT; n = 4); (2) a BAL treatment group (BAL; n = 4) (3) a PE + CHDF treatment group using 1.5 L of norma porcine plasma with CHDF (PE + CHDF, n = 4). Our BA system consisted of a hollow fiber module with 0.2 μm pores and 1 x 1010 of microcarrier-attached hepatocyte inoculated into the extra-fiber space. Each treatment wa initiated 4 h after hepatic devascularization. RESULTS: The pigs in the BAL and the PE + CHD groups survived longer than those in the NT group. The elimination capacity of blood ammonia by both BAL and PE + CHDF was significantly higher than that in NT Aromatic amino acids (AAA) were selectively eliminated by BAL, whereas both AAA and branched chain amino acids, which are beneficial for life, were eliminated by PE + CHDF. Electrolytes maintenance and acid-base balance were better in the CPE + CHDF group than that in the BAL group. CONCLUSION: Our results suggest that PE + CHDF eliminate all factors regardless of benefits, wherea BAL selectively metabolizes toxic factors such as AAA However since PE + CHDF maintain electrolytes and acid-base balance, a combination therapy of BAL plu CPE + CHDF might be more effective for FHF.

Double Plasma Molecular Adsorption System with Sequential Low-dose Plasma Exchange in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure:A Prospective Study

Background and Aims:To investigate the safety and efficacy of double plasma molecular adsorption system(DPMAS)with sequential low-dose plasma exchange(LPE)in treating early hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods:Clinical data of patients with HBVACLF were prospectively collected,including patients in a DPMAS with sequential LPE(DPMAS+LPE)group and those in a standard medical treatment(SMT)group.The primary endpoint was death or liver transplantation(LT)at 12 weeks of follow-up.Propensity-score matching was performed to control the effects of confounding factors on prognosis between the two groups.Results:After 2 weeks,total bilirubin,alanine aminotransferase,blood urea nitrogen levels,and Chinese Group on the Study of Severe Hepatitis B score,were significantly lower in the DPMAS+LPE group than those in the SMT group(p<0.05).After 4 weeks,laboratory parameters of the two groups were similar.The cumulative survival rate of the DPMAS+LPE group was significantly higher than that of the SMT group at 4 weeks(97.9%vs.85.4%,p=0.027),but not at 12 weeks(85.4%vs.83.3%,p=0.687).Cytokine levels were significantly lower in 12-week survival group than in the death-or-LT group(p<0.05).Functional enrichment analysis showed that downregulated cytokines were mainly involved in positive regulation of proliferation and activation of lymphocytes and monocytes,regulation of immune effect response,regulation of endotoxin response,and glial cell proliferation.Conclusion:DPMAS+LPE significantly improved the 4-week cumulative survival rate,and ameliorated the inflammatory response in patients.DPMAS+LPE may be a promising modality for patients with early HBV-ACLF.

Efficacy and Economic Evaluation of Nonbiological Artificial Liver Therapy in Acute-on-chronic Hepatitis B Liver Failure

Background and Aims:Nonbiological artificial liver(NBAL)is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).This study aimed to compare the therapeutic efficacy and cost-effectiveness ratio(CER)of comprehensive medical treatment,plasma exchange(PE),and double plasma molecular adsorption system(DPMAS)plus half-dose PE(DPMAS+PE)in patients with HBV-ACLF.Methods:A total of 186 patients with HBV-ACLF randomly received comprehensive medical treatment,PE,or DPMAS+PE and were prospectively evaluated.Patients were divided into four subgroups based on the pretreatment prothrombin activity(PTA):Group I(PTA>40%),group II(PTA 30–40%),group III(PTA 20–30%),and group IV(PTA<20%).The main outcome measures were 28 day effectiveness;90 day liver transplantation-free survival;change of biochemical parameters;and CER.Results:DPMAS+PE treatment was associated with significantly higher 28 day effectiveness and 90 day liver transplantation-free survival compared with PE treatment in patients with group I liver failure.Clearance of serum total bilirubin(TBIL),AST,and creatinine(Cr)were significantly higher in the DPMAS+PE group than in the PE group.For subjects with group I liver failure,DPMAS+PE treatment had advantages of lower CER values and better cost-effectiveness.Conclusions:Compared with comprehensive medical treatment and PE alone,DPMAS with halfdose sequential PE treatment more effectively improved TBIL,AST,and Cr in HBV-ACLF patients,improved 28 day effectiveness and 90 day survival rates in patients with group I liver failure,and was more cost effective.DPMAS+PE is a viable NBAL approach for treatment of HBV-ACLF.

Effects of therapeutic plasma exchange on survival in patients with postoperative liver failure:a retrospective single-center study

Background:Recent decreases in the incidence of postoperative liver failure(POLF)have been attributed to advances in surgical techniques,critical care,and postoperative management.However,POLF management remains a challenge,and worsening POLF is a significant cause of morbidity and mortality.Therapeutic plasma exchange(TPE)is used as a salvage strategy for POLF in some countries,and several studies conducted between 1980 and 1990 have reported the use of TPE for POLF.We conducted this retrospective single-center study to investigate the outcomes of patients with POLF treated with TPE.Methods:We retrospectively reviewed the charts of patients with POLF admitted to the intensive care unit who underwent TPE between November 2010 and March 2017.POLF was defined as the presence of persistent hyperbilirubinemia.Data on patient demographics,Glasgow Coma Scale score,platelet count,prothrombin time,and serum total bilirubin level were collected,and their Sequential Organ Failure Assessment scores were calculated.The lengths of postoperative hospital stays,lengths of post-TPE hospital stays,and patient outcomes were also analyzed.Results:TPE was performed in 20 patients with POLF during the study period.TPE was initiated on the 49th postoperative day and was performed for a median of five sessions.TPE improved hyperbilirubinemia and coagulopathy but had no effect on neurological and clinical symptoms.All 20 patients treated with TPE died after the 36th day(median)from the initial TPE.Conclusions:Although TPE may improve laboratory values in patients with POLF,the current study suggests that it has no survival benefit.

Plasma exchange in patients with acute and acute-on-chronic liver failure: A systematic review

BACKGROUND Acute liver failure(ALF)and acute-on-chronic liver(ACLF)carry high short-term mortality rate,and may result from a wide variety of causes.Plasma exchange has been shown in a randomized control trial to improve survival in ALF especially in patients who did not receive a liver transplant.Other cohort studies demonstrated potential improvement in survival in patients with ACLF.AIM To assess utility of plasma exchange in liver failure and its effect on mortality in patients who do not undergo liver transplantation.METHODS Databases MEDLINE via PubMed,and EMBASE were searched and relevant publications up to 30 March,2019 were assessed.Studies were included if they involved human participants diagnosed with liver failure who underwent plasma exchange,with or without another alternative non-bioartificial liver assist device.RESULTS Three hundred twenty four records were reviewed,of which 62 studies were found to be duplicates.Of the 262 records screened,211 studies were excluded.Fifty-one articles were assessed for eligibility,for which 7 were excluded.Twenty-nine studies were included for ALF only,and 9 studies for ACLF only.Six studies included both ALF and ACLF patients.A total of 44 publications were included.Of the included publications,2 were randomized controlled trials,14 cohort studies,12 case series,16 case reports.All of three ALF studies which looked at survival rate or survival days reported improvement in outcome with plasma exchange.In two out of four studies where plasma exchange-based liver support systems were compared to standard medical treatment(SMT)for ACLF,a biochemical improvement was seen.Survival in the non-transplanted patients was improved in all four studies in patients with ACLF comparing plasma exchange vs SMT.Using the aforementioned studies,plasma exchange based therapy in ACLF compared to SMT improved survival in non-transplanted patients at 30 and 90-d with a pooled OR of 0.60(95%CI 0.46-0.77,P<0.01).CONCLUSION The level of evidence for use of high volume plasma exchange in selected ALF cases is high.Plasma exchange in ACLF improves survival at 30-and 90-d in nontransplanted patients.Further well-designed randomized control trials will need to be carried out to ascertain the optimal duration and amount of plasma exchange required and assess if the use of high volume plasma exchange can be extrapolated to patients with ACLF.

双重血浆分子吸附联合低剂量血浆置换治疗肝衰竭高胆红素患者的疗效研究

目的探究双重血浆分子吸附(Double Plasma Molecular Absorb System,DPMAS)联合低剂量血浆置换(Plasma Exchange,PE)治疗肝衰竭高胆红素患者的疗效。方法简单随机选取2021年3月—2023年3月潮州市中心医院收治的50例肝衰竭高胆红素患者作为研究对象,采用简单随机化法将其分为DPMAS+PE组(n=25)和PE组(n=25)。观察两组疗效、肝功能、血常规指标与凝血功能。结果DPMAS+PE组总有效率(96.00%)高于PE组(72.00%),差异有统计学意义(P<0.05);DPMAS+PE组谷草转氨酶、总胆红素以及谷丙转氨酶低于PE组,差异有统计学意义(P均<0.05);DPMAS+PE组活化部分凝血酶原时间、凝血酶原活动度优于PE组,差异有统计学意义(P均<0.05)。治疗后两组血红蛋白、血小板计数、白细胞比较,差异无统计学意义(P均>0.05)。结论DPMAS+PE可有效提高在肝衰竭高胆红素患者中的疗效,改善患者的肝功能及凝血功能指标。

血浆置换介入时机与肝损伤分期对劳力性热射病患者预后的影响研究

目的 探讨血浆置换(TPE)介入时机及肝损伤分期辅助治疗劳力性热射病患者(EHS)的预后影响及临床应用价值。方法 收集2011年1月—2023年12月在中国人民解放军总医院第一医学中心收治的EHS患者127例,根据临床结局分为死亡组与生存组2组,根据ALT、AST、TBIL、DBIL指标动态变化分为5期;经倾向性评分匹配分析,生存组11例、死亡组12例被纳入统计分析。行TPE辅助治疗20例;观察治疗前后指标变化及临床结局,评价介入时机对预后的影响。结果 23例患者中,没有肝损伤和可进展到肝脏修复期的共14例,死亡3例、病死率21.43%;不能进展到肝脏修复期9例,死亡9例,病死率100%,2者比较有差异(P<0.05)。首次TPE如在肝损伤第3期之前介入的病死率为23.08%(3/13),达到或超过第3期才介入的病死率85.71%(6/7),2者比较有差异(P<0.05)。结论 EHS合并肝损伤的患者应在肝损伤第3期之前积极行TPE治疗,阻断其病理生理过程,使之跃过第3期,从而改善预后和降低病死率。

Combined use of non-biological artif icial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome

BACKGROUND:Acute liver failure(ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders,the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artif icial liver treatments for patients with acute liver failure(ALF) complicated by multiple organ dysfunction syndrome(MODS).METHODS:Thirty-one patients with mid- or late-stage liver failure complicated by MODS(score 4) were randomly divided into three treatment groups:plasmapheresis(PE) combined with hemoperfusion(HP) and continuous venovenous hemodiafiltration(CVVHDF),PE+CVVHDF,and HP+CVVHDF,respectively. Heart rate(HR) before and after treatment,mean arterial pressure(MAP),respiratory index(PaO2/FiO2),hepatic function,platelet count,and blood coagulation were determined.RESULTS:Signifi cant improvement was observed in HR,MAP,PaO2/FiO2,total bilirubin(TBIL) and alanine aminotransferase(ALT) levels after treatment(P<0.05). TBIL and ALT decreased more signifi cantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups(P<0.01). Prothrombin time(PT) and albumin were signifi cantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups(P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups(P<0.05). The survival rate of the patients was 58.1%(18/31),viral survival rate 36.4%(4/11),and non-viral survival rate 70%(14/20).CONCLUSION:Liver function was relatively improved after treatment,but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites,especially bilirubin. The survival rate was signifi cantly higher in the patients with non-viral liver failure than in those with viral liver failure.

双重血浆分子吸附系统序贯半量血浆置换改善乙肝相关慢加急性肝衰竭患者的短期预后

目的探讨双重血浆分子吸附系统序贯半量血浆置换(DPMAS+HPE)治疗对乙肝相关慢加急性肝衰竭(HBV-ACLF)患者短期生存率的影响。方法回顾性收集2015年1月1日至2022年12月31日在本院住院治疗的HBV-ACLF病例资料,按照治疗方式的不同分为内科综合治疗组和DPMAS+HPE组,倾向得分匹配消除组间混杂偏差,比较2组基线资料及治疗后实验室指标改善情况,Logistic回归分析HBV-ACLF患者死亡相关危险因素,Kaplan-Meier生存分析比较2组30 d和90 d累计生存率。结果本研究共纳入373例HBV-ACLF病例,其中治疗组136例在内科综合治疗基础上接受1次DPMAS+HPE。237例单纯接受内科综合治疗,经倾向得分匹配(PSM)后纳入136例患者作为对照组。治疗组治疗前后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总蛋白(TP)下降幅度(446.5 vs 159.0、317.0 vs 92.0、5.2 vs 0.3)显著大于对照组,差异具统计学意义(P<0.05);DPMAS+HPE治疗是HBV-ACLF患者30 d和90 d死亡独立保护因素(30 d:OR=0.497,P<0.05;90 d:OR=0.436,P<0.05);治疗组30 d和90 d累计生存率显著高于对照组(30 d:50.71%vs 44.12%,P<0.05;90 d:30.15%vs 22.79%,P<0.05)。结论DPMAS+HPE能改善HBV-ACLF患者肝功能和短期生存率,可作为1种有效治疗HBV-ACLF患者的人工肝模式。

不同模式人工肝治疗对肝衰竭患者肝肾功能及凝血功能的影响

目的:分析对肝衰竭患者开展不同模式的人工肝治疗的影响。方法:选取2022年1—9月九江市第一人民医院收治的75例肝衰竭患者,经随机数字表法划分成A组、B组、C组,各25例,A组进行双重血浆分子吸附(DPMAS)+血浆置换(PE),B组进行血浆透析滤过(PDF),C组开展PE,比较三组症状改善效果、实验室指标、终末期肝病模型(MELD)评分的变化,并统计不良反应发生情况。结果:三组治疗后的有效率、不良反应发生率基本一致(P>0.05)。三组治疗前血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(Cr)、白蛋白(ALB)、国际标准化比值(INR)、凝血酶原活动度(PTA)、MELD评分差异均无统计学意义(P>0.05);治疗后,三组TBIL、ALT、AST、Cr、INR、MELD评分较治疗前均降低,C组ALB、PTA较治疗前均升高,A、B组ALB、PTA较治疗前均降低(P<0.05);三组间治疗后的TBIL、ALT、AST、Cr、INR、MELD评分比较,差异均无统计学意义(P>0.05),C组ALB、PTA均高于A、B组(P<0.05)。结论:肝衰竭患者中,将DPMAS+PE、PDF、PE进行灵活应用的疗效良好,无明显优劣,对临床症状的改善均有着较为理想的应用价值。

双重血浆分子吸附系统序贯血浆置换治疗HBV感染相关慢加急性肝衰竭疗效及对患者血清内毒素和炎症因子水平的影响

目的:分析双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)治疗乙型肝炎病毒感染相关慢加急性肝衰竭(HBV-ACLF)疗效及对患者血清内毒素和炎症因子水平的影响。方法:将92例HBV-ACLF患者根据非随机同期对照研究及患者自愿原则分为DPMAS序贯PE组(n=45例)和PE组(n=47例)。PE组接受单纯PE治疗,DPMAS序贯PE组接受DPMAS序贯PE治疗。比较两组患者治疗4周及12周时的好转率及存活率;比较两组治疗前、治疗4周及12周时的血清炎性因子、内毒素水平(ET)及终末期肝病模型(MELD)评分;比较两组并发症发生情况。结果:两组治疗4周好转率比较有统计学差异(P<0.05),治疗12周好转率比较无统计学差异(P>0.05);两组治疗4周及12周存活率比较无统计学差异(均P>0.05);治疗4周及12周时,DPMAS序贯PE组血清C反应蛋白(CRP)、白细胞介素6(IL-6)、中性粒细胞/淋巴细胞比值(NLR)及ET水平低于PE组(均P<0.05);DPMAS序贯PE组治疗4周时的MELD评分低于PE组(P<0.05);两组治疗期间肺部感染、电解质紊乱、肝肾综合征等并发症发生率比较无统计学差异(均P>0.05)。结论:DPMAS序贯PE治疗HBV-ACLF患者,可有效降低血清炎症因子及内毒素水平,应用效果良好。

凉血解毒利湿方联合血浆置换对乙肝相关慢加急性肝衰竭患者预后的临床观察

目的观察凉血解毒利湿方联合血浆置换对乙肝相关慢加急性肝衰竭(HBV-ACLF)患者预后的影响。方法76例HBV-ACLF患者按随机数字表法分为对照组与观察组各38例。对照组予以血浆置换治疗,观察组在对照组的基础上联合凉血解毒利湿方。治疗3周后,对比两组治疗前后中医证候积分、肝功能[白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)]、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)]、T淋巴细胞亚群水平,并对治疗的有效率、安全性以及患者预后情况进行评价。结果治疗后,两组患者的中医证候积分均降低,且观察组身目俱黄、高热烦渴、舌红苔黄、小便色黄、倦怠乏力等积分低于对照组(P<0.05);治疗后,两组患者的ALB、IL-10、CD4+、CD4+/CD8+均升高,ALT、AST、TBil、TNF-α、IL-6、CD8+均下降(P<0.05),且观察组上述指标的改善幅度大于对照组(P<0.05);观察组治疗总有效率为92.11%,高于对照组的73.68%(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论凉血解毒利湿方联合血浆置换治疗HBV-ACLF效果较好,能明显缓解患者的临床症状,调节其肝功能与免疫功能状态,抑制炎症反应,促进预后,较为安全。

血浆置换联合双血浆分子吸附系统对3~4级药物性肝损伤的疗效

目的评估血浆置换(PE)和双血浆分子吸附系统(DPMAS)联合治疗3~4级药物性肝损伤患者的效果。方法回顾性分析岳阳市中心医院2020年6月至2021年2月接诊的64例3~4级药物性肝损伤患者的临床资料。其中PE联合DPMAS治疗32例,单纯药物治疗32例。对比治疗前后两组临床疗效、TBil、ALT、AST、凝血功能指标(PT)的变化,并对不良临床反应的发生情况进行记录。结果PE联合DPMAS组的总有效率为87.5%(28/32),比单纯药物组的65.6%(21/32)明显提高。PE联合DPMAS组在降低胆红素和提高凝血功能(P值分别为0.017和0.025)方面有更好的表现,而两组治疗后转氨酶比较差异无统计学意义(P值分别为0.497和0.103)。两组不良事件发生率无明显差异。结论采用PE联合DPMAS治疗3~4级药物性肝损伤疗效确切,安全性高。