目的 探讨双重血浆分子吸附系统(double plasma molecular adsorption system,DPMAS)联合半量血浆置换(plasma exchange,PE)在乙型肝炎病毒相关慢加急性肝衰竭患者中的疗效。 方法 回顾性选择2021年1月—2022年12月在新乡医学院第一附属医院行人工肝治疗的肝衰竭患者100例,按照不同人工肝治疗模式分为DPMAS+半量PE组(n=49)和PE组(n=51),比较2组治疗后实验室指标的变化和28天生存时间,采用K-M法绘制生存曲线,并采用Log-rank检验分析组间生存差异。多因素COX回归分析影响患者预后的独立因素。 结果 治疗后,DPMAS+半量PE组C反应蛋白(CRP)(t=-3.214,P=0.002)、白蛋白(t=-5.064,P＜0.001)、直接胆红素(t=-2.007,P=0.045)、间接胆红素水平(t=-2.310,P=0.021)均低于PE组。与治疗前比较,治疗后DPMAS+半量PE组和PE组总胆红素(t=-6.974,P＜0.001；t= -7.693,P＜0.001)、直接胆红素(t=-6.711,P＜0.001；t=-6.649,P＜0.001)、间接胆红素(t=-7.365,P＜0.001；t=-7.713,P＜0.001)、国际标准化比值(Z=-3.509,P=0.002；Z=-4.067,P＜0.001)、CRP(t=6.602,P＜0.001；t=5.12,P＜0.001)、白细胞介素6(Z=-5.347,P＜0.001；Z=-4.615,P＜0.001)均降低,凝血酶原活动度(t=-3.322,P＜0.001；t=-5.201,P＜0.001)升高。DPMAS+半量PE组28d生存率高于PE组(χ2=4.209,P=0.040)。多因素COX回归分析显示DPMAS+半量PE治疗(HR=0.832,95% CI：0.685～0.994,P=0.043)、并发症(HR=4.595,95% CI：1.328～7.395,P=0.005)、终末期肝病模型(model for end-stage liver disease,MELD)评分(HR=3.258,95% CI：1.247～5.593,P=0.009)、肝衰竭分期(HR=4.852,95% CI：1.352～7.529, P=0.002)为影响患者预后的独立因素。 结论 DPMAS+半量PE组和PE组治疗均可改善患者的肝功能和凝血指标,DPMAS+半量PE组可以改善患者28天生存率,作为患者预后保护因素,可以减轻临床用血压力,值得临床推广应用。
Objective To explore the efficacy of double plasma molecular adsorption system combined with half-dose plasma exchange (DPMAS+half-dose PE) in patients with hepatitis B-related acute-on-chronic liver failure. Methods A total of 100 patients with liver failure and undergoing artificial liver treatment at the First Affiliated Hospital of Xinxiang Medical University from January 2021 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on the treatment mode: DPMAS+half-dose PE (49 cases) and plasma exchange (PE) alone (51 cases). Changes of laboratory indicators and 28-day survival rate were compared between the two groups. Kaplan-Meier (K-M) method was used to plot survival curves. Log-rank test was employed to analyze survival difference between groups. Multivariate Cox regression analysis was used to identify the independent factors affecting patient prognosis. Results After treatment, levels of CRP [(9.9±4.5)mg/L vs. (12.9±5.0) mg/L], albumin [(27.38±3.94)g/L vs. (31.07±3.35)g/L], direct bilirubin [(102.3±54.9)μmol/L vs. 117.4±43.3)μmol/L] and indirect bilirubin [(69.9±43.4)μmol/L vs. (81.2±34.9)μmol/L] were lower in DPMAS+half-dose PE group than in PE group (t=-3.214, -5.064, -2.007 and -2.310 respectively; P=0.002, ＜0.001, 0.045 and 0.021 respectively). Both groups showed decreases of total bilirubin (t= -6.974, P＜0.001; t=-7.693, P＜0.001), direct bilirubin (t=-6.711, P＜0.001; t=-6.649, P＜0.001) indirect bilirubin (t=-7.365, P＜0.001; t=-7.713, P＜0.001), international normalized ratio (Z=-3.509, P=0.002; Z=-4.067, P＜0.001), CRP (t=6.602, P＜0.001; t=5.12, P＜0.001), and interleukin-6 (Z=-5.347, P＜0.001; Z=-4.615, P＜0.001), and increase of prothrombin activity (t=-3.322, P＜0.001; t=-5.201, P＜0.001) after treatment. The 28-day survival rate was higher in DPMAS+half-dose PE group than in PE group (χ2=4.209, P=0.040). Multivariate Cox regression analysis revealed that DPMAS+PE treatment (HR=0.832, 95% CI: 0.685～0.994, P=0.043), complications (HR=4.595, 95% CI:1.328～7.395, P=0.005), model for end-stage liver disease (MELD) score (HR=3.258, 95% CI: 1.247～5.593, P=0.009), and liver failure stage (HR=4.852, 95% CI: 1.352～7.529, P=0.002) were the independent factors affecting patient prognosis. Conclusion Both the two treatment modalities can improve liver function and coagulation indicators in the patients. DPMAS+half-dose PE group was superior in 28-day survival rate and can reduce the demand for blood transfusion, being a prognostic protective factor for the patients and worthy of clinical promotion.
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