血浆透析滤过治疗肝衰竭的有效性与安全性研究  

Efficacy and safety of lasmadiafiltration inthetrea ment of liver failure

作　　者：代明金[1] 赵媛 王芳[1] 陈志文[1] 杨莹莹[1] 马元吉[2] 张凌[1] 付平[1] DAI Mingjin;ZHAO Yuan;WANG Fang;CHEN Zhiwen;YANG Yingying;MA Yuanji;ZHANG Ling;FU Ping(Department of Nephrology and Institute of Kidney Diseases,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院肾脏内科/肾脏病研究所,成都610041 [2]四川大学华西医院感染性疾病中心,成都610041

出　　处：《华西医学》2024年第7期1063-1067,共5页West China Medical Journal

基　　金：北京肝胆相照公益基金会人工肝专项基金(iGandanF-1082022-RGG043)。

摘　　要：目的探讨血浆透析滤过(plasma diafiltration,PDF)治疗肝衰竭的有效性及安全性。方法选择2020年12月-2022年12月于四川大学华西医院因肝衰竭需要人工肝治疗患者。将患者按照治疗模式分为PDF组、双重血浆分子吸附系统(double plasma molecular adsorption system,DPMAS)组和血浆置换(plasma exchange,PE)组。检测分析3组患者治疗前后总胆红素和白蛋白水平变化情况,并观察严重不良事件发生情况。结果共纳入患者88例,累计治疗179例次。其中,PDF组27例,累计治疗62例次;PE组18例,累计治疗33例次;DPMAS组43例,累计治疗84例次。3组患者在年龄、性别,及治疗前总胆红素、国际标准化比值、白蛋白、血红蛋白、pH值、血钠、血钾、血游离钙、乳酸比较,差异均无统计学意义(P>0.05)。3组在治疗前后总胆红素下降绝对值和总胆红素下降百分比、治疗前后白蛋白变化绝对值和白蛋白变化百分比比较,差异均无统计学意义(P>0.05)。DPMAS组发生一过性低血压1例;PDF及PE组发生过敏反应分别为2例和3例;PE组发生低钙血症2例。结论PDF可安全应用于肝衰竭患者,其降低胆红素的效果与DPMAS及PE相当。PDF与PE相比可节约血浆资源,且可同时实现超滤,尤其适用于肝衰竭伴有肾功不全少尿的患者。Objective To explore the safety and efficacy of plasma diafiltration(PDF)in the treatment of liver failure.Methods s Patients with liver failure requiring artificial liver treatment in West China Hospital of Sichuan University from December 2020 to December 2022 were selected and divided into three groups according to treatment modality:PDF group,double plasma molecular adsorption system(DPMAS)group and plasma exchange(PE)group.Serum albumin levels and total bilirubin(TB)levels were tested before and after treatments to compare the clearance of these substances among three groups.Adverse events were recorded.Results A total of 88 patients were included,with a total of 179 treatments conducted.Among them,27 cases in PDF group were treated for 62 times.In PE group,18 cases were treated for 33 times.In DPMAS group,43 cases were treated for 84 times.There were no significant differences between the three groups in age,sex,TB,international standardized ratio,albumin,hemoglobin,blood pH value,blood sodium,blood potassium,blood free calcium,or lactate(P>0.05).There was no statistically significant difference in the absolute value of TB decrease,percentage of TB decrease,absolute value of albumin change,and percentage of albumin change before and after treatment among the three groups(P>0.05).Transient hypotension occurred in one patient in DPMAS group.There were two and three allergic reactions in PDF and PE groups,respectively.In addition,2 patients in PEgroup had hypocalcemia.Conclusions PDF can be safely used in patients with liver failure,and its therapeutic effect on reducing bilirubin is similar to DPMAS and PE groups.Compared with PE,it needs less plasma supplement.As it can provide ultrafiltration,PDF would be helpful in patients with liver failure accompanied by renal insufficiency oliguria.

关 键 词：血浆透析滤过 肝衰竭 双重血浆分子吸附系统 血浆置换 

分 类 号：R575.3[医药卫生—消化系统]