DPMAS联合PE辅助内科综合治疗ACLF前期患者的临床疗效

摘要/Abstract

摘要： 目的分析双重血浆分子吸附系统(DPMAS)联合血浆置换(PE)辅助内科综合治疗慢加急性肝衰竭(ACLF)前期患者的效果。方法回顾性分析 2020年4月至2023年12月重庆大学附属三峡医院救治的146例ACLF前期患者临床资料。其中采用内科综合治疗(包括去除病因、保肝退黄、促进肝细胞生长、支持对症等)64例,在内科综合治疗基础上给予DPMAS联合PE人工肝治疗82例。比较两组患者治疗前、治疗1周及治疗4周后肝功能指标、电解质、凝血功能、AFP、终末期肝病模型(MELD-Na)评分以及不良反应发生情况。结果治疗1周后,内科治疗组总有效率为53.13%(34/64),联合治疗组总有效率为79.27%(65/82)(P<0.05)。两组患者治疗1周、4周后TBil、DBil、AST、ALT、GGT、ALP、LDH、总胆汁酸(TBA)水平均低于治疗前(P<0.05)。联合治疗组患者1周、4周后TBil分别为(152.09±77.19)μmol/L、(49.29±6.74)μmol/L,DBil分别为(130.14±69.73)μmol/L、(38.56±6.75)μmol/L,AST分别为(192.84±54.82)U/L、(45.37±6.18)U/L,ALT分别为(256.83±119.27)U/L、(42.88±6.58)U/L,GGT分别为(152.47±35.25)U/L、(84.69±10.69)U/L,ALP分别为(143.83±34.15)U/L、(108.12±11.74)U/L,LDH分别为(199.54±56.73)U/L、(180.81±20.75)U/L,TBA分别为(187.01±42.38)μmol/L、(71.78±6.83)μmol/L,均低于内科治疗组(P<0.05)。两组患者治疗1周、4周后Na⁺、K⁺、CI^-、凝血酶原活动度(PTA)水平均较治疗前升高(P<0.05),凝血酶原时间(PT)均降低(P<0.05)。联合治疗组治疗1周后Na⁺(138.81±10.16)mmol/L、K⁺(3.89±0.34)mmol/L、CI^-(101.25±7.68)mmol/L、PTA(68.90±5.68)%水平更高(P<0.05),PT(13.64±4.06)s水平低于内科治疗组(P<0.05)。两组患者治疗1周、4周后WBC、中性粒细胞计数、中性粒细胞/淋巴细胞比值(NLR)、AFP、MELD-Na评分均降低(P<0.05),淋巴细胞计数水平均升高(P<0.05)。与内科治疗组比较,联合治疗组1周、4周后WBC分别为(5.72±0.82)×10⁹/L、(5.12±0.54)×10⁹/L,中性粒细胞计数分别为(3.21±0.53)×10⁹/L、(2.61±0.39)×10⁹/L,NLR分别为(2.93±0.58)、(2.12±0.35),AFP分别为(68.32±8.47)ng/mL、(24.18±4.12)ng/mL,MELD-Na分别为(14.13±3.08)分、(6.72±2.15)分,水平更低(P<0.05),淋巴细胞计数水平更高,分别为(1.89±0.31)×10⁹/L、(2.14±0.29)×10⁹/L(P<0.05)。两组患者治疗1周后Hb、血小板计数、Alb水平均降低(P<0.05),但联合治疗组上述指标下降更为显著(P<0.05)。两组不良反应发生率、病死率比较差异无统计学意义(P>0.05)。结论 DPMAS模式人工肝联合PE辅助内科综合治疗ACLF前期患者更有利于提高临床疗效,改善肝功能、凝血功能、水电解质平衡,减轻机体炎症反应程度,延缓病情进展,且安全性较高。

关键词: ACLF前期, 双重血浆分子吸附系统, 血浆置换, 内科综合治疗

Abstract: Objective To analyze the effect of dual plasma molecular adsorption system (DPMAS) model of artificial liver combined with plasma exchange (PE) as an auxiliary medical treatment to improve the treatment outcome of patients at early stage of acute-on-chronic liver failure (pre-ACLF). Methods The clinical data of 146 patients with pre-ACLF were retrospectively analyzed, all of whom were treated from April 2020 to December 2023. The subjects were divided into a control group and a treatment group according to different treatment methods. Sixty-four cases in the control group received comprehensive medical treatment (including medicines to remove the etiology, protect liver function, promote liver cell growth, and relieve symptoms, etc.). In the 82 cases of the treatment group, DPMAS combined with PE artificial liver therapy was given on the basis of comprehensive medical treatment. Liver function indexes, data of electrolytes, coagulation function, alpha-fetoprotein (AFP) and model of end-stage liver disease (MELD-Na) were collected at before treatment, 1 week and 4 weeks after treatment. The occurrence of adverse reactions in the two groups was analyzed. Results The total effective rate in the treatment group was 79.27%, which was higher than that of 53.13% in the control group (P<0.05). Compared to before treatment, the levels of total bilirubin (TBil), direct bilirubin (DBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and total bile acid (TBA) in both groups were lower after 1 week and 4 weeks of treatment (P<0.05). The levels of TBil[(152.09±77.19)μmol/L, (49.29±6.74)μmol/L], DBil[(130.14±69.73)μmol/L, (38.56±6.75)μmol/L] and AST[(192.84±54.82)U/L, (45.37±6.18)U/L], ALT[(256.83±119.27)U/L, (42.88±6.58)U/L], GGT[(152.47±35.25)U/L, (84.69±10.69)U/L], ALP[(143.83±34.15)U/L, (108.12±11.74)U/L], LDH[(199.54±56.73)U/L, (180.81±20.75)U/L], TBA[(187.01±42.38)μmol/L, (71.78±6.83)μmol/L] in the treatment group after 1 week and 4 weeks of treatment, respectively, were lower than those of the control group (P<0.05). Compared with before treatment, the levels of Na⁺, K⁺, Cl^- and prothrombin activity (PTA) were increased after 1 week and 4 weeks of treatment in both groups (P<0.05), whereas the levels of prothrombin time (PT) were decreased (P<0.05). Compared with the control group, Na⁺, K⁺, Cl, PTA levels in the treatment group were higher (P<0.05), and PT levels were lower (P<0.05) after 1 week of treatment. Compared with before treatment, white blood cell count (WBC), neutrophil count, neutrophil/lymphocyte ratio (NLR), AFP and MELD-Na levels were decreased after 1 week and 4 weeks of treatment in both groups (P<0.05), whereas lymphocyte count levels were increased (P<0.05). In the treatment group, the levels of WBC count [(5.72±0.82) ×10⁹/L, (5.12±0.54)×10⁹/L], neutrophil count [(3.21±0.53)×10⁹/L, (2.61±0.39)×10⁹/L], NLR[(2.93±0.58), (2.12±0.35)], AFP[(68.32±8.47) ng/mL, (24.18±4.12) ng/mL], MELD-Na[(14.13±3.08) min, (6.72±2.15) min] after 1 week and 4 weeks of treatment, respectively, were lower when compared to those of the control group (P<0.05), whereas the lymphocyte count level was higher [(1.89±0.31)×10⁹/L, (2.14±0.29)×10⁹/L, respectively] (P<0.05). After 1 week of treatment, the levels of the Hb, platelet count and Alb levels in both groups were decreased (P<0.05), but the above indexes in the treatment group were decreased more significantly (P<0.05). There were no differences in the incidence of adverse reactions and mortality between the two groups (P>0.05). Conclusion DPMAS model of artificial liver combined with PE assisted medical comprehensive treatment for pre-ACLF patients is more conducive in improving clinical efficacy, improving liver function, maintaining water and electrolyte balance, reducing the degree of inflammation in the body, delaying the progression of the disease, and with high safety.

Key words: Prehepatic failure, Dual plasma molecular adsorption system, Plasma exchange, Comprehensive medical treatment

赵晓春, 安选, 王勇, 朱红旭, 余海燕, 郝丽娟. DPMAS联合PE辅助内科综合治疗ACLF前期患者的临床疗效[J]. 肝脏, 2026, 31(3): 331-335.

ZHAO Xiao-chun, AN Xuan, WANG Yong, ZHU Hong-xu, YU Hai-yan, HAO Li-juan. An observation study on the effect of dual plasma molecular adsorption system combined with plasma exchange to improve the treatment outcome of patients at early stage of acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2026, 31(3): 331-335.

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