关键词: 双重血浆分子吸附系统, 血浆置换, 乙型肝炎病毒, 肝功能衰竭, 疗效

Abstract: Objective To investigate the efficacy of double plasma molecular adsorption system (DPMAS) and plasma exchange (PE) in patients with HBV-related acute-on-chronic liver failure. Methods Forty patients with HBV-related acute-on-chronic liver failure who were hospitalized in Mengchao Hepatobiliary Hospital of Fujian Medical University from September 2022 to January 2023 were retrospectively collected. The patients were divided into a DPMAS treatment group (group A) and a PE treatment group (group B), with 20 cases in each group. The clinical indicators including blood routine, biochemical indicators, coagulation function, inflammatory indicators and the occurrence of complications were collected before and after treatment, and the MELD value and MELD-Na value before treatment were calculated. All patients were followed up for 3 months. The disease progression, laboratory parameters and liver transplantation-free survival rate during the observation period were compared. Methods 1. There were no significant differences in gender, age, disease stage, complications, clinical indicators, MELD score and MELD-Na score between the two groups before artificial liver treatment (P>0.05). 2.The 3-month liver transplantation-free survival rate was 80% in group A and 70% in group B. There was no statistical difference between the two groups. 3. At 24 hours after treatment, the levels of total bilirubin (TBil) and direct bilirubin (DBil) in the two groups decreased, and the difference was statistically significant (Group A:TBil 362.2(302.8, 443.1) vs. 263.0(219.9, 349.2)μmol/L,Z=-3.003,P=0.003;DBil 180.6(154.7, 222.3) vs. 127.6(112.0, 178.7)μmol/L,Z=-2.867,P=0.004;Group B:TBil 419.2±147.0 vs. 339.7±113.3 μmol/L,t=1.914,P=0.063;DBil 202.9±59.3 vs. 164.5±48.1 μmol/L,t=2.254,P=0.030). Compared with group B, the reduction rate of TBil and DBil in group A was higher ( TBil:25.6±8.3 vs. 17.9±7.4 μmol/L,t=3.090,P=0.004;DBil:25.7±9.2 vs. 18.4±8.1 μmol/L,t=2.682,P=0.011). The prothrombin time (PT) and international normalized ratio (INR) in the group B decreased (PT:28.6(21.1, 32.7) vs. 21.9(17.7, 24.8) s,Z=-2.489,P=0.013;INR:2.7(1.9, 3.2) vs. 1.9(1.4, 2.2),Z=-2.462,P=0.014), whereas the prothrombin time activity (PTA) increased (31.2±11.1% vs. 42.7±13.7%,t=-2.918,P=0.006). There was no significant difference in coagulation indexes before and after treatment in group A. Group B had a significant increase in albumin (Alb) [11.8(7.1, 21.4) vs. 8.0(5.4, 12.0)g/L,Z=-2.002,P=0.045], whereas group A had no significant difference in Alb before and after treatment. Group A had a decrease in C-reactive protein (CRP) after treatment, while group B had no significant difference in CRP before and after treatment. 4. At72 hours after treatment: TBil and DBil in DPMAS treatment group continued to decrease and had statistical significance [TBil:362.2(302.8, 443.1) vs. 297.8(213.4, 394.6)μmol/L,Z=-2.110,P=0.035;DBil:180.6(154.7, 222.3) vs. 143.8(102.8, 184.9)μmol/L,Z=-2.218,P=0.027]. While TBil and DBil in group B had no statistical significance before and after treatment; There was no significant difference in coagulation function between the two groups before and after treatment. The patients in group B had a significant reduction in hemoglobin (Hb) before and after treatment (121.4±14 vs. 111.3±12.3 g/L,t=2.423,P=0.020), whereas group A had no significant difference in HB before and after treatment. There was no statistically significant difference in 3-month liver transplantation-free survival rate between group A and group B patients. Conclusion DPMAS is superior to PE in the clearance of bilirubin and inflammatory mediators such as CRP. DPMAS treatment has no significant effect on coagulation function.

Key words: Double plasma molecular adsorption system, Plasma exchange, Hepatitis B virus, Liver failure, Efficacy