Efficacy analysis of double plasma molecular adsorption system combined with half-volume plasma ex-change in patients with hepatitis B-related acute-on-chronic liver failure
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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(x2=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 retrospec-tively 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 analy-sis 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 respec-tively;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 bili-rubin(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(x2=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 prog-nostic protective factor for the patients and worthy of clinical promotion.
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