单次血浆置换与双重血浆分子吸附系统治疗慢加急性肝衰竭的疗效比较分析  

Effects of one session therapy of plasma exchange or double plasma molecular adsorption system on acute-on-chronic liver failure

作　　者：陈晓泓 谢烨卿 张宁萍 胡家昌 於佳炜 姜物华 王莉 滕杰 丁小强 周俭 沈波 许佳瑞 CHEN Xiaohong;XIE Yeqin;ZHANG Ningping;HU Jiachang;YU Jiawei;JIANG Wuhua;WANG Li;TENG Jie;DING Xiaoqiang;ZHOU Jian;SHEN Bo;XU Jiarui(Department of Nephrology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院肾内科,上海200032 [2]上海市肾病与透析研究所 [3]复旦大学附属中山医院消化科,上海200032 [4]复旦大学附属中山医院肝外科,上海200032

出　　处：《上海医学》2025年第1期17-22,共6页Shanghai Medical Journal

基　　金：上海市科学技术委员会上海市肾脏疾病与血液净化重点实验室项目(14DZ2260200、20DZ2271600)。

摘　　要：目的比较单次血浆置换(plasma exchange,PE)与双重血浆分子吸附系统(double plasma molecular adsorption system,DPMAS)治疗乙型肝炎病毒(hepatitis B virus,HBV)相关慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)的疗效,探索相关影响因素。方法回顾性收集2019年1月—2021年12月就诊于复旦大学附属中山医院的18~75岁的HBV相关ACLF患者资料,根据人工肝支持(artificial liver suppont,ALS)治疗模式将患者分为PE组和DPMAS组。PE组以新鲜冰冻血浆(fresh frozen plasma,FFP)和4%白蛋白(albumin,ALB)溶液为置换液。比较单次PE与DPMAS治疗前、后相关实验室指标的变化。结果本研究共纳入89例患者,PE组47例、DPMAS组42例。与DPMAS组相比,PE组患者基线血红蛋白水平、血小板计数,以及FIB水平均显著减低,而PT显著延长(P值均<0.05)。两组间白细胞计数、超敏C反应蛋白(hs-CRP)、总胆红素(TBil)、ALT、ALB、球蛋白(GLB)、血钠水平和终末期肝病模型(model for end-stage liver disease,MELD)评分,以及治疗前收缩压、舒张压的差异均无统计学意义(P值均>0.05)。与同组治疗前相比,治疗后PE组患者的PT显著缩短(P=0.0001),TBil、ALT、GLB和hs-CRP水平均显著减低(P值均<0.005),而DPMAS组患者PT显著延长(P=0.0101),FIB、TBil和ALB水平较治疗前均显著减低(P值均<0.05)。治疗后,PT、ALB、FIB、TBil和ALT水平的变化幅度在PE组和DPAMS组间的差异均有统计学意义(P值均<0.05);而GLB和hs-CRP水平的变化幅度在两组间的差异均无统计学意义(P值均>0.05)。在校正参数基线水平和检测时间点后,ALS的治疗模式是治疗后PT、ALT、FIB、TBil和ALB水平变化幅度的独立影响因素,其中选择DPMAS治疗方式与患者PT和ALT水平的下降幅度呈显著负相关(β=-0.6365、P=0.001,β=-0.3946、P=0.009),而与FIB、TBil和ALB水平的下降幅度呈显著正相关(β=0.2675、P=0.004,β=0.1025、P<0.001,β=0.1204、P<0.001)。结论DPMAS治疗对TBil的去除率�Objective To compare the therapeutic effects of single plasma exchange(PE)and double plasma molecular adsorption system(DPMAS)in the treatment of acute-on-chronic liver failure(ACLF)related to hepatitis B virus(HBV)infection,and to explore the related influencing factors.Methods Data from patients aged 18 to 75 years with HBV related ACLF who visited Zhongshan Hospital,Fudan University from January 2019 to December 2021 were retrospectively collected.The patients were divided into PE and DPMAS groups based on the artificial liver support(ALS)modalities.The PE group used fresh frozen plasma(FFP)and 4%albumin(ALB)solution as replacement fluids.Changes in relevant laboratory indicators before and after single PE and DPMAS treatments were compared.Results A total of 89 patients were included in this study,with 47 in the PE group and 42 in the DPMAS group.Compared with the DPMAS group,the PE group had significantly lower baseline levels of hemoglobin(Hb),platelet(PLT)count,and fibrinogen(FIB)concentration,while prothrombin time(PT)was significantly prolonged(all P<0.05).There were no statistically significant differences between the two groups in white blood cell(WBC)count,high-sensitivity C-reactive protein(hs-CRP),total bilirubin(TBil),alanine aminotransferase(ALT),ALB,globulin(GLB),serum sodium levels,Model for End-Stage Liver Disease(MELD)score,or systolic and diastolic blood pressure before treatment(all P>0.05).Compared with before treatment,the PE group had significantly shortened PT(P=0.0001)and significantly reduced levels of TBil,ALT,GLB,and hs-CRP after treatment(all P<0.005).In the DPMAS group,PT was significantly prolonged(P=0.0101)and FIB,TBil and ALB levels were significantly reduced compared with before treatment(both P<0.05).After treatment,the changes in PT,ALB,FIB,TBil,and ALT levels showed statistically significant differences between the PE group and the DPAMS group(all P<0.05).However,the changes in GLB and hs-CRP levels showed no statistically significant differences between the two groups(all P

关 键 词：血浆置换 双重血浆分子吸附系统 慢加急性肝衰竭 乙型肝炎病毒 

分 类 号：R715.6[医药卫生—妇产科学]