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.

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.

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

AIM： To characterize and evaluate the therapeutic efficacy of bioartificial liver （BAL） as compared to that of continuous hemodiafiltration （CHDF） with plasma exchange （PE）, which is the current standard therapy for 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 normal porcine plasma with CHDF （PE ＋ CHDF, n -- 4）. Our BAL system consisted of a hollow fiber module with 0.2 i^m pores and 1 × 10^10 of microcarrier-attached hepatocytes inoculated into the extra-fiber space. Each treatment was initiated 4 h after hepatic devascularization. RESULTS： The pigs in the BAL and the PE ＋ CHDF 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, whereas BAL selectively metabolizes toxic factors such as AAA. However since PE ＋ CHDF maintain electrolytes and acid-base balance, a combination therapy of BAL plus CPE ＋ CHDF might be more effective for FHF.

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.

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.

Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China:A large,multicenter,retrospective cohort study using a propensity score matching analysis

Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.

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.

双重血浆分子吸附系统序贯血浆置换联合连续性肾脏替代疗法治疗慢加急性肝衰竭合并急性肾损伤的效果分析

目的观察双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)联合连续性肾脏替代疗法(CRRT)治疗慢加急性肝衰竭(ACLF)合并急性肾损伤(AKI)患者的临床效果。方法回顾性纳入2019年1月—2022年12月于贵州医科大学附属医院住院治疗的ACLF合并AKI的90例患者临床资料,依据不同的血液净化方式,分为DPMAS序贯PE联合CRRT组(观察组,n=31),DPMAS序贯PE组(对照组,n=59)。收集所有患者入院一般资料、血液净化治疗前后实验室指标,包括肝肾功能、凝血功能、炎症指标等,计算eGFR、MELD-Na评分。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料组内前后比较采用Wilcoxon符号秩和检验,两组间比较采用Mann-Whitney U检验。计数资料两组比较采用χ^(2)检验或Fisher精确检验。结果观察组治疗有效率为48.4%(15/31),高于对照组治疗的有效率27.1%(16/59)(χ^(2)=4.071,P=0.044)。两组血液净化方式均可有效改善TBil、ALT、AST、PTA、Scr、PCT、CRP、e GFR及MELD-Na评分(P值均<0.05);两组治疗后PLT及Hb均显著降低(P值均<0.05);而BUN、Alb、INR治疗前后差异均无统计学意义(P值均>0.05)。对照组与观察组的AST、Scr、PCT、e GFR、MELD-Na评分、Hb、PLT治疗前后差值比较,差异均有统计学意义(P值均<0.05)。结论DPMAS序贯PE联合CRRT模式可有效清除炎症介质,改善肾功能,稳定机体内环境,获得较好的临床疗效。

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。

个性化护理对行人工肝血浆置换术治疗重型肝炎患者负面情绪的影响分析

目的探讨重型肝炎患者接受人工肝血浆置换术治疗期间的个性化护理措施及护理效果。方法选取2023年2月至2024年1月期间于我院接受人工肝血浆置换术治疗的80例重型肝炎患者作为研究对象,分为观察组(个性化护理)和对照组(常规护理)各40例,对比两组的焦虑和抑郁情绪严重程度、遵医行为、护理满意度、生活质量、睡眠质量以及不良反应发生情况。结果评价焦虑、抑郁情绪(护理后),观察组患者的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分低于对照组(P<0.05);评价遵医行为,观察组的优良率高于对照组(P<0.05);评价护理满意度,观察组的满意度评分高于对照组(P<0.05);评价生活质量(护理后),观察组的健康调查简表(SF-36)评分高于对照组(P<0.05);评价睡眠质量(护理后),观察组患者的匹茨堡睡眠质量指数量表(PSQI)评分低于对照组(P<0.05);对比不良反应发生情况,观察组的不良反应发生率低于对照组(P<0.05)。结论重型肝炎患者接受人工肝血浆置换术治疗期间,个性化的护理的开展,可以减少负面情绪对于病情恢复的不良影响,改善患者的身心状态,提高治疗效果。

医护一体化模式干预在人工肝血浆置换治疗患者不良反应预防中的效果观察

[目的]观察医护一体化模式在预防人工肝血浆置换患者不良反应中的应用效果.[方法]回顾性分析2020年1月—2024年12月间收治的肝功能衰竭行人工肝血浆置换60例患者临床资料,根据患者接受不同护理干预措施分成两组,其中将给予常规护理的30例列入对照组,给予医护一体化模式护理干预的30例列入研究组.比较两组患者护理前、后舒适度、不良情绪及生活质量评分、不良反应发生情况及护理干预满意度.[结果]两组干预后舒适度评分及生活质量评分均较干预前显著提高(P<0.05),与对照组干预后比较,观察组干预后2项评分均明显提高(P<0.05);干预后两组不良情绪评分均较干预前明显降低(P<0.05),干预后研究组评分与对照组干预后相比显著降低(P<0.05);干预后研究组不良反应发生率明显低于对照组,对于护理干预的总满意率均明显高于对照组,差异均具有统计学意义(P<0.05).[结论]给予人工肝血浆置换患者医护一体化模式干预可提高患者舒适度与生活质量,降低不良情绪评分,减少不良反应的发生,提高满意度,效果满意.

PDF治疗过程中总胆红素反弹的危险因素分析

目的探讨慢加急性肝功能衰竭患者行血浆透析滤过治疗过程中与总胆红素反弹有关的危险因素。方法回顾性分析2021年1月-2023年1月本院重症医学科收治的79例慢加急性肝功能衰竭(乙型病毒性肝炎)患者的临床资料,所有患者进入ICU后均接受血浆透析滤过(Plasmadiafiltration,PDF)治疗,以患者住院期间总胆红素水平为研究焦点,根据入院后第一次PDF治疗前后24 h总胆红素水平的变化差异,将患者分为未反弹组(总胆红素水平较治疗前下降>20%)与反弹组(总胆红素水平较治疗前升高>20%)。记录并比较两组患者一般资料、SOFA评分、Child-pugh评分、是否合并感染、治疗后各实验室指标平均值、总住院时间、ICU住院时间及6个月生存率的差异。采用Spearman分析各指标与胆红素反弹的相关性。采用Logistic回归分析治疗过程中引起胆红素反弹的相关危险因素。采用试者工作特征曲线(Receiver operator characteristic curve,ROC曲线)评价各危险因素对胆红素反弹的预测价值。结果79例慢加急肝功能衰竭接受PDF治疗的患者中,有28例在第一次接受PDF治疗后总胆红素水平下降>20%,在后续治疗中逐渐下降至正常水平,有51例患者在第一次接受PDF治疗后,有胆红素反弹>20%现象的发生。通过对两组患者的临床资料进行分析发现,两组患者在PDF治疗前是否合并有糖尿病,、肝性脑病、腹水、感染差异具有统计学意义(P<0.05),治疗前SOFA评分、Child-pugh评分具有差异(P<0.05),治疗过程中WBC、PCT、ATⅢ、血氨、总胆红素平均水平的变化和6个月生存情况均具有明显差异(P<0.05)。经过Spearman分析得知,合并糖尿病及ATⅢ水平与胆红素反弹呈负相关(r均<0,P<0.05);合并肝性脑病、腹水、感染以及SOFA评分、Child-pugh评分、WBC、PCT、血氨水平与胆红素反弹呈正相关(r均>0,P<0.05)。多因素Logistic回归分析,结果显示Child-pugh高评分是胆红素反弹的独立危险因素(OR=10.490,95%CI为2.047~53.753,P=0.005)。ROC曲线分析显示:Child-pugh肝功能评分高低对肝功能衰竭患者PDF治疗后胆红素反弹具有一定预测价值,ROC曲线下面积AUC=0.931,95%CI为0.851~0.976,P<0.0001;当最佳截断值为10.5%时,其敏感度和特异度分别为94.12%和78.57%。结论Child-pugh评分越高,患者肝功能越差,若同时合并感染及多脏器功能不全行PDF治疗后胆红素反弹的风险越高。

预见性护理对人工肝血浆置换术治疗重症肝炎肝衰竭患者的焦虑情绪及并发症的影响

目的探讨预见性护理对人工肝血浆置换术治疗重症肝炎肝衰竭患者的焦虑情绪及并发症的影响.方法选取我院2022年1月—2023年11月收治的62例重症肝炎肝衰竭患者为研究对象,2022年1-11月收治的患者为对照组(n=32),2023年1-11月收治的患者为观察组(n=30).所有患者均采用人工肝血浆置换术治疗,术后对照组采用常规护理,观察组采用预见性护理.比较两组患者的焦虑情绪及并发症发生情况,并调查护理满意度.结果护理后,观察组汉密尔顿焦虑量表评分为(8.54±2.12)分,低于对照组的(10.05±2.27)分,护理满意度为100.00%,高于对照组的81.25%,并发症发生率为6.67%,低于对照组的25.00%,组间差异有统计学意义(P<0.05).结论预见性护理能够减轻人工肝血浆置换术治疗重症肝炎肝衰竭患者的焦虑情绪,减少并发症的发生,提高护理满意度.

人工肝支持系统治疗重症肝炎临床研究

目的：探讨人工肝支持系统（ＡＬＳＳ）治疗重症肝炎（重肝）的疗效和血浆置换（ＰＥ）、血浆吸附（ＰＰ）、血液灌流（ＤＨＰ）治疗重肝的适应证。方法：治疗组６４ 例，对照组６０ 例。２ 组病例内科基础治疗相同，治疗组加用ＡＬＳＳ治疗，其中ＰＥ每次置换４０～６０ ｍ ｌ／ｋｇ 异体同型等量血浆；ＰＰ每次交换１００～１５０ ｍ ｌ／ｋｇ 血浆；ＤＨＰ每次交换１７０～２５０ ｍ ｌ／ｋｇ 全血量，２～７ 日治疗１ 次，直到病情稳定好转。结果：治疗组共计治疗１６８ 例次，平均２．６ 次，存活４４ 例，存活率６８．７５％ ；对照组存活２８ 例，存活率４６．６７％ （Ｐ＜ ０．０１）。治疗组早、中、晚期存活率分别为８５．７１％ 、７６．４７％ 和５２．１７％ ，ＰＥ、ＰＰ和ＤＨＰ治疗存活率分别为７３．８１％ 、６６．６７％ 和５０．００％ 。结果显示ＰＥ适合中毒症状严重的各型重肝，ＰＰ宜用于严重胆汁淤积的重肝，ＤＨＰ以降低ＮＨ３ 为主，适宜高氨血症和肝性脑病的治疗。治疗过程中发生不良反应２４ 例次（１５．５８％ ），经对症处理不良反应均能缓解。结论：ＡＬＳＳ治疗重症肝炎能有效清除体内病理成分，包括血清总胆红素、血氨、肿瘤坏死因子和内毒素等，提高存活率，降低?

新型人工肝组合技术双重血浆分子吸附联合血浆置换与单纯血浆置换治疗肝衰竭

背景:双重血浆分子吸附不仅能特异性吸附胆红素和胆汁酸,还可以清除体内毒素、炎症递质、细胞因子,在缺乏血浆或血浆不足的情况下,可有效清除有害物质,防止多脏器功能衰竭,为肝脏再生、肝功能的恢复争取时间,适用于各种原因引起的肝衰竭。目的:对比新型双重血浆分子吸附联合血浆置换与单纯血浆置换治疗肝衰竭的有效性和安全性。方法:收集2014年10月至2017年10月在贵州省人民医院收治的肝衰竭患者60例,随机分为2组,每组30例。血浆置换组单纯采用血浆置换治疗,血浆置换量为2 500-3 000 mL;联合组采用双重血浆分子吸附联合血浆置换治疗,血浆置换量为1 000-1 500 mL。均于治疗3次后评估临床效果及肝功能,并观察人工肝治疗过程中出现的不良反应。结果与结论:①治疗后2组血清总胆红素、谷丙转氨酶水平较治疗前显著降低,凝血酶原活动度水平较治疗前显著升高(P <0.05),但治疗前后联合组血清白蛋白水平差异无显著性意义,治疗后联合组血清总胆红素、谷丙转氨酶、血清白蛋白水平显著低于血浆置换组,凝血酶原活动度水平显著高于血浆置换组(P <0.05);②联合组治疗总有效率(83%)显著高于血浆置换组(63%)(P <0.05);③联合组人工肝治疗过程中出现皮疹、寒战、低血压各1例;血浆置换组未出现不良反应;④结果提示,双重血浆分子吸附联合血浆置换与单纯血浆置换均可以显著改善肝衰竭患者肝功能,且不良反应少。但双重血浆分子吸附与血浆置换联合应用的治疗效果更具优势,同时可以减少血浆用量。

双重血浆吸附、胆红素吸附及血浆置换治疗肝衰竭的疗效比较

目的观察双重血浆吸附(DPMAS)、胆红素吸附(PBA)及血浆置换(PE)治疗肝衰竭的临床疗效,寻找能替代血浆置换的新模式。方法将南华大学附属南华医院40例行人工肝治疗的肝衰竭患者,分为DPMAS组、PBA组和PE组,观察生化指标、不良反应和临床症状,并行治疗前后对比和3组间多重对比。结果DPMAS和PE均能显著降低总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)及C反应蛋白(CRP),升高凝血酶原时间活动度(PTA)。PBA仅降低TBI和DBIL,对其他疗效不显著。PE组降低TBIL、ALT和升高PTA的效果最佳。DPMAS组与之相近,且CRP下降率高于PE组。3组治疗均能不同程度改善临床症状,PE组的不良反应明显,DPMAS组好转率高于其他两组。结论双重血浆吸附术的疗效明显优于胆红素吸附术,与血浆置换相当,又能显著清除炎症因子,克服血浆缺乏和过敏等缺点,仅需增加设备和费用的支持,可作为替代血浆置换的新模式。

血浆置换治疗肝功能衰竭

目的 :观察血浆置换治疗肝功能衰竭的临床疗效。方法 :对 1 1例肝功能衰竭患者采用血浆置换治疗 (血浆置换组 ) ,9例采用常规药物治疗 (对照组 ) ,观察血浆置换对肝功能恢复的影响 ,并分析其疗效。 结果 :血浆置换后患者血清总胆红素(TBIL )明显下降 [(32 5± 1 2 4 ) vs (5 1 0± 1 1 0 )μmol/L ,P<0 .0 5 ];凝血酶原时间缩短 [(2 6± 1 2 ) vs (38± 1 1 ) s,P<0 .0 5 ],但治疗前后丙氨酸转氨酶 (AL T)变化不显著 [(85 2± 2 2 1 ) vs (795± 1 95 ) U/L ]。血浆置换组存活率 (7/1 1 )高于对照组 (3/9,P<0 .0 5 )。 结论 :血浆置换治疗可改善肝功能 ,并可提高患者生存率 ,是目前治疗肝功能衰竭的重要手段之一。

混合型生物人工肝治疗HBV相关慢加急性肝衰竭患者的初步探讨

目的利用自行构建的混合型生物人工肝系统,探讨其治疗HBV相关慢加急性肝衰竭患者的安全性和有效性。方法采用转染人肝再生增强因子(hALR)的HepG2细胞为生物材料,构建中空纤维生物反应器。以2009年5月-2011年8月住院的HBV相关慢加急性肝衰竭患者作为治疗对象,随机分为2组,每组10例,治疗组进行混合型生物人工肝治疗,对照组进行普通血浆置换治疗。两组间均数比较采用成组t检验,治疗前后比较采用配对t检验。结果治疗组10例患者中,7例经住院治疗临床好转出院,其余1例因肝性脑病死亡,1例因肝肾综合征死亡,1例出院后死于肝衰竭。对照组10例患者中存活5例,其余1例肝移植,4例因肝衰竭死亡。2组患者治疗前MELD评分分别为24.26±2.54及24.71±2.79,差异无统计学意义(t=1.971,P=0.064)。治疗组治疗3 d、1、4周MELD评分平均分别为21.71±2.92、22.10±4.46、19.90±5.43。跟踪随访1 a,治疗组和对照组患者血清甲胎蛋白平均值分别为14.24、11.32 ng/ml,腹部B超检查均未发现肝脏占位性病变。结论自行构建的混合型生物人工肝支持系统治疗HBV相关慢加急性肝衰竭患者具有一定安全性和有效性。

羟乙基淀粉代血浆在人工肝支持系统中治疗肝衰竭的应用及安全性

目的探讨羟乙基淀粉部分代替血浆在人工肝支持系统中治疗肝衰竭的应用方法及安全性。方法 45名肝衰竭患者应用全血浆、低比例(≤25%)或高比例(>25%)羟乙基淀粉代替血浆进行血浆置换或血浆置换联合吸附人工肝治疗,共124人次,比较各种方法治疗前后生化指标变化及副反应发生情况。结果用羟乙基淀粉部分代替血浆进行人工肝治疗后,患者的肝功能指标可显著改善,其中经血浆置换联合吸附人工肝治疗对部分肝功能指标的改善强于单纯血浆置换方法,并且羟乙基淀粉应用比例≤25%总置换量时对胆红素等的清除效果更显著,对机体的不良影响更小。结论在人工肝治疗肝衰竭过程中可低比例应用羟乙基淀粉代替血浆,以在一定程度上缓解临床用血的压力。

血浆灌流联合血浆置换治疗慢加急性肝衰竭的效果观察

目的评价血浆灌流(PP)联合血浆置换(PE)治疗慢加急性肝衰竭(ACLF)的临床价值。方法收集2014年1月-2015年12月兰州市第二人民医院感染科收治的72例ACLF患者,所有患者均在内科药物治疗基础上加用人工肝支持系统治疗(根据病情不同,3~4 d进行1次人工肝治疗,平均每例患者进行1~3次),据治疗方法不同分为联合组(n=40,PP联合PE治疗,共107例次)和对照组(n=32,单纯PE治疗,共85例次)。记录患者治疗前、术后及术后72 h的TBil、ALT和PTA。并在治疗4周后进行疗效评价。计量资料2组间比较采用t检验;计数资料2组间比较用χ~2检验。结果所有患者的总有效率为63.89%(46/72);术后72 h联合组和对照组患者的ALT水平比较,差异有统计学意义[(319.54±86.23)U/L vs(354.75±100.76)U/L,t=2.60,P<0.05)];与治疗前比较,2组患者的TBil、ALT水平在术后(联合组:t值分别为6.69、15.84,P<0.05,对照组:t值分别为5.34、14.38,P<0.05)及术后72 h(联合组:t值分别为3.24、8.83,P<0.05,对照组:t值分别为2.40、4.61,P<0.05)均有降低;2组患者的PTA水平在术后与治疗前比较变化明显,差异有统计学意义(t值分别为4.83、5.01,P值均<0.05)。联合组和对照组皮肤瘙痒、皮疹的发生率差异无统计学意义;口周或肢体麻木的发生率差异有统计学意义(10.28%vs 31.76%,χ~2=9.11,P<0.05)。结论 PE联合PP与单纯PE治疗均可有效改善ACLF患者的临床疗效,2组治疗有效率近似;但联合组可节省40%~50%血浆,且降低了PE治疗不良反应的发生率,安全性更高,同时更符合目前血源紧缺的社会现实,是临床治疗手段的更佳选择。