经选择性血浆分离器行人工肝治疗低血小板计数慢加急性肝衰竭患者的效果及安全性分析  

Efficacy and safety of artificial liver support therapy with a selective plasma separator in low-platelet count patients with acute-on-chronic liver failure

作　　者：李守娟 王丽 周明 吴蓓 王磊 段萌 廖洪帆 胡瑞晴 胡朝霞 朱丽 胡娟 LI Shoujuan;WANG Li;ZHOU Ming;WU Bei;WANG Lei;DUAN Meng;LIAO Hongfan;HU Ruiqing;HU Zhaoxia;ZHU Li;HU Juan(Department of Hepatology,Chengdu Public Health Medical Center,Chengdu 610066,China;Center for Artificial Liver Support Therapy,Chengdu Public Health Medical Center,Chengdu 610066,China)

机构地区：[1]成都市公共卫生临床医疗中心肝病科,成都610066 [2]成都市公共卫生临床医疗中心人工肝治疗中心,成都610066

出　　处：《临床肝胆病杂志》2024年第6期1191-1195,共5页Journal of Clinical Hepatology

基　　金：成都市卫生健康委员会(2021435);中国公共卫生联盟课题(第一批)(GWLM202037)。

摘　　要：目的对不同分层血小板计数的慢加急性肝衰竭(ACLF)患者采用Evacure-4A膜型选择性血浆分离器行人工肝治疗,观察其疗效、安全性及对血小板的影响。方法选取2021年1月—2023年5月于成都市公共卫生临床医疗中心肝病科住院的302例低血小板计数ACLF患者,根据血小板计数将其分为3组:A组(血小板计数:25×10^(9)/L~50×10^(9)/L)101例;B组(血小板计数:51×10^(9)/L~80×10^(9)/L)98例;C组(血小板计数:81×10^(9)/L~100×10^(9)/L)103例。所有患者在内科治疗的基础上根据病情给予不同模式人工肝治疗:包括血浆灌流联合血浆置换、双重血浆分子吸附联合血浆置换、胆红素吸附联合血浆置换。计量资料各组治疗前后比较采用配对t检验,多组间比较采用方差分析,进一步两两比较采用SNK-q检验。计数资料多组间比较采用χ2检验。结果88.74%(268/302)患者人工肝治疗后临床症状呈不同程度改善。治疗后各组患者肝功能ALT(t值分别为14.755、21.614、15.965)、AST(t值分别为11.491、19.301、3.919)、TBil(t值分别为19.182、17.486、21.75)较治疗前均呈不同程度下降(P值均<0.001);INR呈不同程度缩短(t值分别为3.497、3.327、4.358,P值均<0.05)。使用Evacure-4A膜型选择性血浆分离器行人工肝治疗后,A、B、C组血小板计数分别由治疗前(37.73±6.27)×10^(9)/L、(66.97±7.64)×10^(9)/L、(93.82±5.38)×10^(9)/L降至治疗后(36.59±7.96)×10^(9)/L、(62.59±7.37)×10^(9)/L、(85.99±12.49)×10^(9)/L,其中B、C组治疗前后比较均有统计学差异(t值分别为12.993、8.240,P值均<0.001),A组治疗前后比较无统计学差异(P>0.05)。3组间人工肝治疗中不良反应的发生率差异无统计学意义(P>0.05)。结论人工肝治疗能改善ACLF患者的肝功能及INR,使用Evacure-4A膜型选择性血浆分离器在人工肝治疗过程中对血小板的影响较小,治疗血小板明显低下ACLF患者是安全的。Objective To investigate the efficacy and safety of artificial liver support therapy with an Evanure-4A selective membrane plasma separator and its influence on platelet count in the treatment of patients with acute-on-chronic liver failure(ACLF)patients with different platelet counts.Methods A total of 302 patients with ACLF who were hospitalized in Department of Hepatology,Chengdu Public Health Clinical Medical Center,from January 2021 to May 2023,were enrolled,and according to the platelet count(PLT),they were divided into group A(25×10^(9)/L—50×10^(9)/L)with 101 patients,group B(51×10^(9)/L—80×10^(9)/L)with 98 patients,and group C(81×10^(9)/L—100×10^(9)/L)with 103 patients.In addition to medical treatment,all patients received different modes of artificial liver support therapy based on their conditions,including plasma perfusion combined with plasma exchange,double plasma molecular adsorption combined with plasma exchange,and bilirubin system adsorption combined with plasma exchange.The paired t-test was used for comparison of continuous data before and after treatment in each group;an analysis of variance was used for comparison between multiple groups,and the SNK-q test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between multiple groups.Results Of all 302 patients,268(88.74%)achieved varying degrees of improvement in clinical symptoms after artificial liver support therapy.After treatment,all three groups had varying degrees of reductions in alanine aminotransferase(t=14.755,21.614,and 15.965,all P<0.001),aspartate aminotransferase(t=11.491,19.301,and 13.919,all P<0.001),total bilirubin(t=19.182,17.486,and 21.75,all P<0.001),and international normalized ratio(INR)(t=3.497,3.327,and 4.358,all P<0.05).After artificial liver support therapy with an Evanure-4A selective membrane plasma separator,PLT in group A decreased from(37.73±6.27)×10^(9)/L before treatment to(36.59±7.96)×10^(9)/L after treatment,PLT in group B decrease

关 键 词：慢加急性肝功能衰竭 肝 人工 血小板计数 

分 类 号：R575.3[医药卫生—消化系统]