还原型谷胱甘肽联合PE+DPMAS治疗慢加急性肝衰竭的效果及预后评分模型的建立

肝脏 ›› 2023, Vol. 28 ›› Issue (3): 334-339.

还原型谷胱甘肽联合PE+DPMAS治疗慢加急性肝衰竭的效果及预后评分模型的建立

许海玲, 章颖, 俞冲, 王忠成, 陈琳

226006 江苏南通市第三人民医院,南通大学附属南通第三医院肝病一科(许海玲,俞冲),重症感染科(章颖),中西医结合肝病科(王忠成),肝病研究所(陈琳)

收稿日期:2023-01-10 出版日期:2023-03-31 发布日期:2023-08-28
通讯作者: 章颖
基金资助:
江苏省卫健委科研项目(Z2020011);南通市科技局科研基金项目(MSZ20099);南通市卫计委局青项目(MB2020038)

Effects of reduced glutathione combined with plasma exchange and Double plasma molecular absorb system on acute-on-chronic liver failure and the establishment of a prognostic scoring model

XU Hai-ling¹, ZHANG Ying², YU Chong¹, WANG Zhong-cheng³, CHEN Lin⁴

1. Department of Liver Disease 1, Nantong Third People's Hospital,Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;
2. Department of Critical Infection,Nantong Third People's Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;
3. Department of Integrated Chinese and Western medicine Hepatology,Nantong Third People's Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;
4. Institute of Liver Diseases,Nantong Third People's Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China

Received:2023-01-10 Online:2023-03-31 Published:2023-08-28
Contact: ZHANG Ying

摘要/Abstract

摘要： 目的探讨还原型谷胱甘肽联合PE+DPMAS对慢加急性肝衰竭(ACLF)患者肝功能的影响及预后评分模型的建立。方法回顾性选择2018年5月至2021年5月南通市第三人民医院确诊的84例ACLF患者,随机分为PE+DPMAS组(A组)和还原型谷胱甘肽+PE+DPMAS组(B组),每组各42例。记录患者6个月的生存状态,然后将B组分为生存组与死亡组。进行两组基线资料比较,两组治疗3个月的肝功能指标、临床疗效对比。分析6个月生存影响因素;建立6个月生存预测ROC模型。结果 B组INR为 1.82(1.48～2.20),A组2.18(1.52～2.87)(Z=-4.350,P=0.003;B组Cr水平为0.63(0.40～0.71),A组0.78(0.62～0.85)(Z=-2.256,P=0.006);B组MELD评分为23.69(17.85～27.02),A组24.67(22.37～28.86)(Z=-5.307,P<0.001);B组MELD-Na评分21.25(16.69～29.95),A组25.66(21.84～31.67)(Z=-4.892,P<0.001)。治疗3个月后,B组AST水平为(42.11±9.85)U/L,A组(68.02±13.79)U/L(t=9.909,P<0.001);B组TBil水平为(21.55±6.32)μmol/L,A组(32.77±6.09)μmol/L(t=8.285,P<0.001);B组γ-GT水平为(32.55±9.07)U/L,A组(78.05±15.79)U/L(t=16.193,P<0.001);B组ALT水平为(45.38±10.73)U/L,A组(78.05±15.79)(t=7.589,P<0.001)。两组患者均未发生死亡,B组治疗总有效率(92.86%)明显高于A组(76.19%)(χ²=4.459,P<0.05)。根据患者6个月生存情况,将B组患者分为生存组(25例)与死亡组(17例)。COX多因素分析显示,年龄(OR=1.013,95%CI:1.102～1.03)、TBil(OR=1.003,95%CI:1.024～1.085)、INR(OR=1.101,95%CI:1.132～2.387)、 PLT(OR=1.008,95%CI:1.092～1.101)是患者生存的独立危险因素。依据COX结果,建立B组治疗的肝衰竭预后预测模型(A模型)。在ROC曲线中,A模型预测的AUC为0.752(95%CI:0.660～0.845),大于MELD评分模型(0.662,95%CI:0.557～0.768)和MELD-Na评分模型(0.702,95%CI:0.605～0.799)。结论还原型谷胱甘肽联合PE+DPMAS能明显促进患者肝功能恢复,年龄、TBil、INR和 PLT是患者生存独立危险因素,新模型对患者生存预测效能明显优于传统MELD评分和MELD-Na评分模型。

关键词: 慢加急性肝衰竭, 还原型谷胱甘肽, 血浆置换, 双重血浆分子吸附系统, 终末期肝病模型评分

Abstract: Objective To explore the effect of reduced glutathione combined with plasma exchange and double plasma molecular absorb system (PE+DPMAS) on liver function of patients with acute-on-chronic liver failure and establish a prognostic scoring model. Methods A total of 84 patients with acute-on-chronic liver failure diagnosed from May 2018 to May 2021 were retrospectively selected. The patients were randomly divided into PE+DPMAS group (group A) and reduced glutathione+PE+DPMAS group (group B), with 42 cases in each group. The 6-month survival status of the patients was recorded. The patients in Group B were further divided into a survival group and a death group. The baseline data, liver function indexes and clinical efficacy after 2 months of treatment between these two groups were compared. The influencing factors of six-month survival were analyzed. The ROC model for predicting 6-month survival was established. Results The INR of group B and group A was 1.82 (1.48-2.20) and 2.18 (1.52-2.87), respectively (Z=-4.350, P=0.003); the level of Cr in group B and group A was 0.63 (0.40-0.71) and 0.78 (0.62～0.85), respectively (Z=-2.256, P=0.006); MELD score of group B and group A was 23.69 (17.85～27.02) and 24.67 (22.37～28.86), respectively (Z=-5.307, P<0.001); The MELD-Na score of group B and group A was 21.25 (16.69-29.95), and 25.66 (21.84-31.67), respectively (Z=-4.892, P<0.001). After 3 months of treatment, the AST level of group B and group A was 42.11±9.85 and 68.02±13.79, respectively (t=9.909, P<0.001); the level of TBIL in group B and group A was 21.55±6.32 and 32.77±6.09, respectively (t=8.285, P<0.001); γ-GT level in group B and group A was 32.55±9.07 and 78.05±15.79, respectively (t=16.193, P<0.001); the ALT level in group B and group A was 45.38±10.73 and 78.05±15.79, respectively (t=7.589, P<0.001). There was no death in both groups, and the total effective rate of 92.86% in group B was significantly higher than that of 76.19% in group A (χ²=4.459, P<0.05). According to the 6-month survival, patients in group B were divided into a survival group (25 cases) and a death group (17 cases). COX multivariate analysis showed that age (OR=1.013, 95%CI: 1.102-1.03), TBil (OR=1.003, 95%CI: 1.024-1.085), INR (OR=1.101, 95%CI: 1.132-2.387), PLT (OR=1.008, 95%CI: 1.092-1.101) were independent risk factors for the patients' survival. According to the COX results, a prediction model (A model) for the prognosis of liver failure in group B treatment was established. In the ROC curve, the AUC area of 0.752 (95%CI: 0.660-0.845) predicted by the A model was larger than that of 0.662 (95%CI: 0.557-0.768) by the MELD scoring model and 0.702 (95%CI: 0.605-0.799) by the MELD-Na scoring model. Conclusion Reduced glutathione+PE+DPMAS can significantly promote the recovery of liver function in patients with acute-on-chronic liver failure. Age, TBil, INR and PLT are independent risk factors for the patients' survival. The new A model is significantly better than traditional MELD score and MELD-Na in predicting the prognosis of patients' survival.

Key words: Acute-on-chronic liver failure, reduced glutathione, plasma exchange, double plasma molecular absorb system, MELD score

许海玲, 章颖, 俞冲, 王忠成, 陈琳. 还原型谷胱甘肽联合PE+DPMAS治疗慢加急性肝衰竭的效果及预后评分模型的建立[J]. 肝脏, 2023, 28(3): 334-339.

XU Hai-ling, ZHANG Ying, YU Chong, WANG Zhong-cheng, CHEN Lin. Effects of reduced glutathione combined with plasma exchange and Double plasma molecular absorb system on acute-on-chronic liver failure and the establishment of a prognostic scoring model[J]. Chinese Hepatolgy, 2023, 28(3): 334-339.

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