首页|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

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

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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，Ka-plan-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、3 17。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;90d: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 DP-MAS+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。
Double plasma molecular adsorption system and sequential half-dose plasma exchange improves short-term prog-nosis of patients with hepatitis B associated acute-on-chronic liver failure
Objective To investigate the effect of double plasma molecular adsorption system and sequential half-dose plasma exchange(DPMAS+HPE)on the short-term survival rate of patients with hepatitis B associated acute-on-chronic liver failure(HBV-ACLF).Methods Data on HBV-ACLF cases hospitalized in our hospital from January 1,2015 to December 31,2022 were retrospectively collected,and were divided into standard comprehensive medical treat-ment group and DPMAS+HPE group according to different treatment methods.Propensity score matching(PSM)was used to eliminate inter group confounding bias.The baseline data and improvement of laboratory indicators after treat-ment between two groups were compared.Death related risk factors in HBV-ACLF patients were screened by logistic re-gression analysis,and cumulative survival rates at 30 and 90 days between the two groups were compared by Kaplan-Meier survival analysis.Results A total of 373 cases of HBV-ACLF were included in this study.Among them,136 cases in the treatment group received DPMAS+HPE once on the basis of comprehensive internal medicine treatment,and 237 cases only received comprehensive internal medicine treatment.After PSM,136 patients were included as the control group.The decrease in alanine aminotransferase(ALT),aspartate aminotransferase(AST),and total protein(TP)in the treatment group before and after treatment was significantly greater than that in the control group(446.5 vs 159.0,317.0 vs 92.0,5.2 vs 0.3),with statistically significant difference(P＜0.05).DPMAS+HPE treatment is an independent protective factor for mortality in HBV-ACLF patients at 30 and 90 days(30 days:OR=0.497,P＜0.05;90 days:OR=0.436,P＜0.05).The cumulative survival rates at 30 and 90 days in the treatment group were significantly higher than those in the control group(30 days:50.71％vs 44.12％,P＜0.05;90 days:30.15％vs 22.79％,P＜0.05).Conclusion DP-MAS+HPE improves the short-term prognosis of HBV-ACLF patients and can serve as an effective artificial liver model for the treatment of HBV-ACLF patients.

Hepatitis B associated acute-on-chronic liver failure(HBV-ACLF)double plasma molecular adsorp-tion system(DPMAS)plasma exchangeprognostic outcome

吴承高、刘威、况林菊、刘强、熊伟、胡飘萍、张长林、乐爱平

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南昌大学江西医学院南昌大学第一附属医院输血医学科,江西南昌 330006

南昌大学江西医学院南昌大学第一附属医院江西省输血医学重点实验室,江西南昌 330006

乙肝相关慢加急性肝衰竭 双重血浆分子吸附系统 血浆置换 预后转归

江西省重点研发计划项目江西省卫生健康委科技项目江西省输血医学重点实验室

20192ACB5001420231020520212BCD42006

2024

10.13303/j.cjbt.issn.1004-549x.2024.01.002

中国输血杂志
中国输血协会 中国医学科学院输血研究所

中国输血杂志

CSTPCD
影响因子：1.279
ISSN：1004-549X
年,卷(期)：2024.37(1)
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