摘要
目的观察双重血浆分子吸附(DPMAS)、血浆置换(PE)及双重血浆分子吸附联合低置换量血浆置换(DPMAS+LPE)3种非生物型人工肝治疗肝衰竭的疗效。方法以109例非生物型人工肝治疗的肝衰竭患者为研究对象,回顾性收集其临床资料,根据治疗模式不同分为3组,包括DPMAS组,PE组和DPMAS+LPE组。对3组患者的疗效进行对比。结果首次非生物人工肝治疗后24 h内3组患者总胆红素(TBil)(284.65±89.90,218.10±73.75,t=6.345;256.73±98.55,194.41±89.91,t=9.374;245.63±60.75,176.26±49.72,t=9.413,均P<0.001)、直接胆红素(DBil)(195.52±86.36,152.97±69.22,t=5.297;182.81±86.03,113.42±64.74,t=5.630;170.56±46.22,125.64±41.38,t=8.107,均P<0.001)、丙氨酸氨基转移酶(ALT)[109.50(33.25~342.50),101.50(28.75~208.25),Z=-3.198,P=0.001;86.00(35.50~199.00),64.00(36.50~133.00),Z=-3.751,P<0.001;49.00(30.00~123.75),37.50(27.75~101.25),Z=-3.324,P=0.001]均显著下降;PE组白蛋白(Alb)水平显著升高(31.25±5.33,32.87±7.11,t=-2.200,P=0.034);DPMAS组血红蛋白(Hb)(96.47±18.48,84.88±23.82,t=3.919,P<0.001)和纤维蛋白原(FIB)(2.36±2.02,1.67±0.89,t=2.764,P=0.009)显著下降。3组间两两比较,PE组和DPMAS+LPE组的MELD评分下降率[0.13(0.09~0.27),0.19(0.12~0.24)]均显著高于DPMAS组[0.05(0.00~0.11)](均P<0.05);凝血酶原时间(PT)下降率[0.21(0.11~0.35),0.18(0.10~0.32)]均显著高于DPMAS组[0.00(-0.13~0.10)](均P<0.05);国际标准化比值(INR)下降率[0.19(0.11~0.39),0.21(0.13~0.32)]均显著高于DPMAS组[0.02(-0.11~0.11)](均P<0.05);白细胞(WBC)下降率[0.14(-0.05~0.34),0.15(-0.05~0.34)]均显著高于DPMAS组[0.01(-0.30~0.11)](均P<0.05);中性粒细胞与淋巴细胞比值(NLR)下降率[0.26(-0.07~0.45),0.21(0.16~0.46)]均显著高于DPMAS组[-0.14(-0.84~0.09)](均P<0.05);DPMAS组凝血酶原活动度(PTA)下降率[0.00(-0.17~0.12)]分别显著高于PE组[-0.46(-1.09~-0.23)]和DPMAS+LPE组[-0.35(-0.81~-0.16)](均P<0.05);PE组和DPMAS+LPE组两组之间上述指标无显著差异(P>0.05)。3组中DPMAS+LPE组降钙素原(PCT)的下降程度最显著[0.08(-0.09~0.27),0.29(0.13~0.42),0.48(0.34~0.69),KW=30.935,P<0.001]。3组患者生存率差异无统计学意义(47.1%,54.1%,60.5%,χ^(2)=1.953,P=0.377)。结论DPMAS、PE及DPMAS+LPE均可不同程度改善患者肝功能;并且PE及DPMAS+LPE可有效改善凝血功能及炎症反应;DPMAS会降低Hb和FIB;三种非生物型人工肝对生存率影响无显著差异。
Objective To observe the efficacy of three different modes of non-bioartificial liver,which are dual plasma molecular adsorption(DPMAS),plasmapheresis(PE),and dual plasma molecular adsorption combined with low volume plasmapheresis(DPMAS+LPE)three different modes of non-bioartificial liver in the treatment of liver failure:dual plasma molecular adsorption(DPMAS)plasmapheresis(PE)and dual plasma molecular adsorption combined with low volume plasmapheresis(DPMAS+LPE).Methods A total of 109 patients with liver failure treated with non-bioartificial liver were selected as the research objects,and their clinical data were retrospectively collected.According to the different modes of artificial liver supporting system that they received for treatments,the patientsy were divided into three groups:dual plasma molecular adsorption(DPMAS)group,plasma exchange(PE)group,and dual plasma molecular adsorption combined with low volume plasma exchange(DPMAS+LPE)group.To compare tThe efficacy of artificial liver therapy in 3 groups of patients were compared.Results Total bilirubin(TBil)(284.65±89.90,218.10±73.7,t=6.345;256.73±98.53,194.41±89.91,t=9.374;245.63±60.75,176.26±49.72,t=9.413,all P=0.0001),direct bilirubin(DBil)(195.52±86.36,152.97±69.22,t=5.297;182.81±86.03,113.42±64.74,t=5.630;170.56±46.22,125.64±41.38,t=8.107,all P=0.0001)and alanine aminotransferase(ALT)[109.50(33.25~342.50),101.50(28.75~208.25),Z=-3.198,P=0.001;86.00(35.50~199.00),64.00(36.50~133.00),Z=-3.751,P=0.0010;49.00(30.00~123.75),37.50(27.75~101.25),Z=-3.324,P=0.001]in 3 groups of patients decreased significantly within 24 h after the first non-bioartificial liver treatment.Albumin(Alb)level in PE group increased significantly after treatment(31.25±5.33,32.87±7.11,t=-2.200,P=0.034).In DPMAS group,Hemoglobin(Hb)(96.47±18.48,84.88±23.82,t=3.919,P=0.0001)and Fibrinogen(FIB)(2.36±2.02,1.67±0.89,t=2.764,P=0.009)decreased significantly after treatment.Pairwise comparison between groups:The decline rate of MELD score in the PE group[0.13(0.09~0.27)]and DPMAS+LPE group[0.19(0.12~0.24)]was significantly higher than that in the DPMAS group[0.05(0.00~0.11)](P<0.05).The decline rate of prothrombin time(PT)in the PE group[0.21(0.11~0.35)]and DPMAS+LPE group[0.18(0.10~0.32)]was significantly higher than that in the DPMAS group[0.00(-0.13~0.10)](P<0.05).The decline rate of international normalized ratio(INR)in the PE group[0.19(0.11~0.39)]and DPMAS+LPE group[0.21(0.13~0.32)]was significantly higher than that in the DPMAS group[0.02(-0.11~0.11)](P<0.05).The reduction rate of white blood cell(WBC)in the PE group[0.14(-0.05~0.34)]and DPMAS+LPE group[0.15(-0.05~0.34)]was significantly higher than that in the DPMAS group[0.01(-0.30~0.11)](P<0.05).The reduction rate of neutrophil-lymphocyte ratio(NLR)in the PE group[0.26(-0.07~0.45)]and DPMAS+LPE group[0.21(0.16~0.46)]was significantly higher than that in the DPMAS group[-0.14(-0.84~0.09)](P<0.05).The decline rate of prothrombin activity(PTA)in DPMAS group[0.00(-0.17~0.12)]was significantly higher than that in PE group[-0.46(-1.09~-0.23)]and DPMAS+LPE group[-0.35(-0.81~-0.16)],respectively.There was no significant difference in the above indexes between PE group and DPMAS+LPE group(P>0.05).The decrease of procalcitonin(PCT)in DPMAS+LPE group was the most significant[0.08(-0.09~0.27),0.29(0.13~0.42),0.48(0.34~0.69),KW=30.935,P<0.0001].There was no significant difference in survival rate among the three groups(47.1%,54.1%,60.5%,χ^(2)=1.953,P=0.377).Conclusion DPMAS,PE and DPMAS+LPE can improve liver function into different degreeextents.PE and DPMAS+LPE can effectively improve coagulation function and inflammatory response.DPMAS can reduce Hb and FIB.There was no significant difference in survival rate among patients treated with the three non-biological artificial liver systems.
作者
牛丹
李博玲
宗媛
NIU Dan;LI Bo-ling;ZONG Yuan(Department of Intensive Care Unit,Shaanxi Provincial People′s Hospital,Xi′an 710000,China)
出处
《肝脏》
2023年第9期1028-1036,共9页
Chinese Hepatology
关键词
人工肝
血浆置换
肝功能衰竭
Artificial liver
Plasma exchange
Liver failure
