【摘要】目的 观察高胆红素血症患者行双重血浆分子吸附系统治疗的临床疗效，探讨最佳的吸附血浆量。方法 回顾性分析于上海中医药大学附属第七人民医院行双重血浆分子吸附系统治疗的18 例高胆红素血症患者，以单次治疗的血浆吸附量作为治疗剂量分层，统计分析和比较治疗前后患者的血常规、凝血及肝肾功能。结果 18 例患者共行24 次双重血浆分子吸附系统治疗，其中显效2例，有效15例，无效1例，总有效率为94.44%。治疗后患者血清总胆红素、直接胆红素、血小板计数、血浆纤维蛋白原降低(t值分别为16.424, 4.324, 5.124, 2.237；P值分别为＜0.001, 0.001, ＜0.001, 0.039)，C-反应蛋白下降(t=3.519, P=0.003)，凝血酶原时间延长(t=0.245，P=0.041)。单次血浆吸附总量以正常人体血浆量倍数分层(正常人体血浆容量按4000ml 计算，分组为1.5～2.5 倍、2.5～3.5 倍、3.5～4.5 倍、4.5～5.5倍、5.5～6.5 倍)后，结果显示(2.5～3.5 倍人体血浆量)组患者的总胆红素下降率高于(1.5～2.5 倍)组(t=-2.633，P=0.017)，其余各组间比较无统计学意义(P＞0.05)。结论双重血浆分子吸附系统治疗高胆红素血症患者的疗效显著，单次血浆吸附总量为2.5～3.5 倍人体血浆量显示出更好的疗效趋势。
【Abstract】Objective To observe the clinical effects of double plasma molecular adsorption system in the treatment of hyperbilirubinemia patients and to investigate the optimal adsorbed plasma volume. Methods A retrospective analysis was performed for the 18 patients with hyperbilirubinemia treated with double plasma molecular adsorption system in the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine. Patients were grouped according to the total plasma adsorption volume in a single treatment. Their laboratory indicators including blood routine, coagulation function, and liver and kidney functions before and after the treatment were analyzed. Results A total of 24 times of double plasma molecular adsorption
systems were used in the 18 patients, of which 2 cases were markedly effective, 15 cases were effective, and one case was ineffective, with a total effective rate of 94.44%. After the treatment, serum total bilirubin (t=16.424, P＜0.001), direct bilirubin (t=4.324, P＜0.001), platelet count (t=5.124, P＜0.001) plasma fibrinogen (t=2. 237, P=0.039) and C-reactive protein (t=3.519, P=0.003) decreased, and prothrombin time increased (t=0.245, P=0.041). The ratio of total adsorbed plasma volume in a single treatment to total plasma volume in normal individuals (4000 ml) was used to divide the patients into 5 groups: 1.5～2.5 times, 2.5～3.5 times, 3.5～4.5 times, 4.5～5.5 times and 5.5～6.5 times groups. The rate of the total bilirubin reduction was higher in 2.5～3.5 times group than in 1.5～2.5 times group (t=-2.633, P=0.017), but had no significant differences among other groups (P＞0.05). Conclusion The double plasma molecular adsorption system was effective in treating hyperbilirubinemia. The total adsorbed plasma volume in a single treatment in the range of 2.5 to 3.5 times of total plasma volume will have a better therapeutic effect.
[1]黎代强.双重血浆分子吸附系统（DPMAS）治疗重型肝病新进展[J].中国医学工程, 2015, 23(8):198-198
[2]曾湘丽, 肖平, 周巧玲, 等.胆红素吸附治疗高胆红素血症的疗效分析[J].中国现代医学杂志, 2019, 29(3):110-113
[3]赵丽娟, 陈小兰, 柏明, 等.胆红素吸附治疗心脏术后高胆红素血症的临床效果[J].心脏杂志, 2019, 31(5):526-533
[4]Yao J, Li S, Zhou L, et al.Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure[J].Journal of Clinical Apheresis, 2019, :-
[5]闫国胜, 李丽丽, 姜少利, 等.不同吸附剂在双重血浆分子吸附系统治疗肝衰竭中的临床研究[J].中华肝脏病杂志, 2019, 27(1):51-55
[6]周建辉, 陈香美, 杨云生, 等.血浆胆红素吸附时间的探讨[J].军医进修学院学报, 2007, 28(1):40-41
[7]熊墨龙, 熊云逢, 欧阳兵, 等.胆红素吸附联合低容量血浆置换治疗重型肝炎的疗效及安全性评估[J].重庆医学, 2018, 47(7):923-925
[8]同辉, 李巧玲, 胡晓周, 等.胆红素吸附序贯血液净化疗法对肝癌术后肝衰竭患者的肝功能及凝血功能的影响[J].实用癌症杂志, 2020, 35(1):127-130
[9]裴锋博, 龚黎, 陈祖君, 等.白蛋白透析联合胆红素吸附治疗心脏术后急性肝衰竭临床研究[J].中国血液净化, 2017, 16(11):771-773
[10]赵明, 李向东, 李毅, 等.双重血浆分子吸附系统在蜂蛰伤致多器官功能衰竭中的应用[J].中国血液净化, 2015, 14(10):591-595
[11]张宝文, 阳学风, 罗湘俊, 等.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[J].中国现代医学杂志, 2016, 26(12):103-106
[12]李爽, 陈煜.血浆紧缺情况下非生物型人工肝治疗新模式的探讨[J].临床肝胆病杂志, 2017, 33(9):1687-1692
[13]麻开旺, 陈俊平, 李光大.胆红素医用吸附剂研究进展[J].离子交换与吸附, 2014, 30(3):278-288
[14]朴艺花, 夏天皓, 夏书香.双重血浆分子吸附系统治疗例急性肝衰竭疗效观察[J].延边大学医学学报, 2018, 41(2):122-124
[15]秦含玉, 贾佳, 李国福.双重血浆分子吸附系统治疗急性肝衰竭的临床研究[J].中华重症医学电子杂志, 2018, 4(1):31-35
