PE、DPMAS、CVVHDF模式治疗乙肝相关慢加亚急性肝衰竭患者的效果对比  

Efficacy of plasma exchange versus double plasma molecular adsorption system versus continuous veno-venous hemodiafiltration on treating hepatitis B-related acute-on-chronic liver failure

作　　者：徐炜捷 黄水文 刘宝荣 刘宁 蓝丽琴 XU Wei-jie;HUANG Shui-wen;LIU Bao-rong;LIU Ning;LAN Li-qin

机构地区：[1]福建医科大学孟超肝胆医院ICU,福建福州350000

出　　处：《中国疗养医学》2024年第9期86-89,共4页Chinese Journal of Convalescent Medicine

基　　金：福州市科技计划项目(2021-S-241)。

摘　　要：目的探讨血浆置换(PE)、双重血浆分子吸附(DPMAS)、连续性静脉-静脉血液滤过透析(CVVHDF)模式治疗乙肝相关慢加亚急性肝衰竭(HBV-ACLF)患者的效果。方法选取2021年11月至2023年2月于福建医科大学孟超肝胆医院进行治疗的HBV-ACLF患者90例,根据治疗方式不同分为PE组,DPMAS组,CVVHDF组,每组均30例。对比三组患者肝功能指标、凝血功能、内毒素(ET)及高迁移率族蛋白B1(HMGB1)水平,随访60 d生存情况。结果治疗后,三组患者总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间(PT)、凝血酶原活动度(PTA)比较,差异有统计学意义(P<0.05);CVVHDF组TBIL、ALT、AST、PT低于DPMAS组及PE组,CVVHDF组PTA高于DPMAS组及PE组(P<0.05);治疗后,三组患者ET、HMGB1比较,差异有统计学意义(P<0.05);CVVHDF组患者ET、HMGB1水平低于DPMAS组及PE组(P<0.05);随访60 d后,CVVHDF组患者生存率高于DPMAS组及PE组(P<0.05)。结论三种人工肝模式均可改善患者的肝功能、凝血功能、ET和HMGB1水平,提高生存率,但采用CVVHDF效果更优。Objective To explore the efficacy of plasma exchange(PE),double plasma molecular adsorption system(DPMAS)and continuous veno-venous hemodiafiltration(CVVHDF)on treating hepatitis B-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 90 HBV-ACLF patients treated in the Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2021 to February 2023 were recruited.They were divided into PE group,DPMAS group,and CVVHDF group according to different treatment methods,with 30 cases in each group.Liver function indicators,coagulation function,endotoxin(ET),and high mobility group protein B1(HMGB1)levels among three groups were compared.Patients were followed up for the survival status for 60 days.Results After treatment,there were significant differences in total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),prothrombin time(PT),and prothrombin activity(PTA)among the three groups(P<0.05).TBIL,ALT,AST,and PT in the CVVHDF group were significantly lower than those of the DPMAS and PE groups,while PTA in the CVVHDF group was significantly higher than that in the other two groups(P<0.05).After treatment,there were significant differences in ET and HMGB1 levels among the three groups(P<0.05).ET and HMGB1 levels in the CVVHDF group were significantly lower than those of the DPMAS group and PE group(P<0.05).After 60 days of follow-up,the survival rate of patients in the CVVHDF group was significantly higher than that of the DPMAS group and PE group(P<0.05).Conclusion All three artificial liver models can improve liver function,coagulation function,ET and HMGB1 levels,and increase survival rate of HBV-ACLF,but CVVHDF is more effective.

关 键 词：血浆置换 双重血浆吸附 连续性血液透析滤过 乙肝相关慢加亚急性肝衰竭 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]