双重血浆分子吸附联合糖皮质激素治疗重度急性药物性肝损伤的近期疗效观察

摘要/Abstract

摘要： 目的探讨双重血浆分子吸附系统(DPMAS)联合糖皮质激素(GCs)治疗重度急性药物性肝损伤(DILI)的近期疗效。方法选择2019年1月—2021年3月南通大学附属海安医院收治的DILI患者69例,采用随机数字表法分为观察组(n=31)和对照组(n=38),分别采用DPMAS联合GCs治疗和DPMAS治疗;比较治疗前后生化指标、胆红素反弹、肝脏储备、临床疗效及不良反应等指标。结果 2组患者治疗1 周和2 周时的血清总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、凝血酶原总活动度(PTA)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05);凝血酶原时间(PT)水平较治疗前降低,组间无明显差异(P>0.05)。观察组的TBil、DBil水平在治疗后第4 d、第8 d有小幅攀升,但治疗结束、治疗后第4 d、第8 d时,观察组显著低于对照组(P<0.05)。观察组治疗后肝脏储备功能、肝有效循环血量、终末期肝病模型(MELD)评分、DPMAS治疗次数低于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率显著对照组,差异有统计学意义(P<0.05);2组急性肝衰竭发生率和6个月生存率比较明显无差异(P>0.05)。2组治疗后的DILI分级均较治疗前显著改善,观察组改善程度优于对照组(P<0.05)。2组治疗不良反应发生率无统计学意义(P>0.05)。结论 DPMAS联合GCs治疗方案能显著改善重度DILI患者的临床症状及肝功能,显效时间及改善程度高于单用DPMAS治疗。

关键词: 重度药物性肝损伤, 双重血浆分子吸附, 糖皮质激素, 肝脏储备功能, 胆红素反弹

Abstract: Objective To investigate the short-term efficacy of dual plasma molecular adsorption system (DPMAS) combined with glucocorticoids (GCs) in the treatment of severe acute drug-induced liver injury (DILI).Methods A total of 69 DILI patients admitted to Haian Hospital affiliated to Nantong University from January 2019 to march 2021 were randomly divided into observation group (n=31) and control group (n=38) by random number table method. DPMAS combined with GCs or DPMAS alone were used to treat the two groups of patients, respectively. Biochemical indexes, bilirubin rebound, liver reserve function, clinical efficacy and adverse reactions were compared before and after treatment.Results When compared the serum total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), prothrombin total activity (PTA), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and c-reactive protein (CRP) levels between the two groups of patients at 1 week and 2 week after treatment, the differences were statistically significant (P<0.05). Prothrombin time (PT) was lower than that of before treatment, and there was no significant difference within groups (P>0.05). The levels of TBil and DBil in the observation group increased slightly at 4 day and 8 day after treatment, but at the end of treatment, 4 day and 8 day after treatment, the levels in the observation group were significantly lower than those in the control group (P<0.05). The liver reserve function, effective circulating blood volume, model of end-stage liver disease (MELD) score and DPMAS times in the observation group were lower than those in the control group after treatment, the differences were statistically significant (P<0.05). The total effective rate of observation group was significantly higher than control group, and the difference was statistically significant (P<0.05). There were no significant differences in the incidence of acute liver failure and 6-month survival rate between the two groups (P>0.05). The DILI grading of both groups was significantly improved after treatment compared with before treatment, and the improvement degree of observation group was better than that of control group (P<0.05). There was no statistical significance in the incidence of adverse reactions between the two groups (P>0.05).Conclusion DPMAS combined with GCs can significantly improve the clinical symptoms and liver function of patients with severe DILI, and the effect time and improvement degree are higher than those of DPMAS alone.

Key words: Severe drug-induced liver injury, Double plasma molecular adsorption, Glucocorticoid, Liver reserve function, Bilirubin rebounds

丁鹏, 仲海峰. 双重血浆分子吸附联合糖皮质激素治疗重度急性药物性肝损伤的近期疗效观察[J]. 肝脏, 2022, 27(11): 1198-1202.

DING Peng, ZHONG Hai-feng. Short-term efficacy of dual plasma molecular adsorption combined with glucocorticoid in the treatment of severe acute drug-induced liver injury[J]. Chinese Hepatolgy, 2022, 27(11): 1198-1202.

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