双重血浆分子吸附系统治疗药物性肝损伤伴高胆红素血症患者的临床观察

摘要/Abstract

摘要： 目的分析DPMAS治疗DILI伴高胆红素血症疗效,以冀丰富该少见病例的临床诊疗资料。方法收集DILI伴高胆红素血症患者95例,基于施行方案的差异分为观察(PE+DPMAS)、对照组(PE),并从不同组别、不同治疗阶段(治疗前后)在临床指标及其变化率等方面予以全面比较。结果在临床指标本身数值方面,治疗后观察组ALT、AST、TBA、TBil及DBil为56(35,70)U/L、49(30,73)U/L、59.4(43.2,70.2)μmol/L、102.7(69.4,148.7)μmol/L及84.5(56.8,128.7)μmol/L,均较对照组改善显著[77(50,102)U/L、71(52,97)U/L、78.5(56.2,84.7)μmol/L、145.9(92.3,206.5)μmol/L及122.4(78.9,154.0)μmol/L,P<0.05]。在临床指标变化率方面,治疗后观察组TBA、TBil和DBil下降率显著高于对照组(P<0.05)。在围治疗阶段炎症指标方面,观察组治疗后TNF-α、IL-6及hs-CRP为21.6(17.5,28.0)pg/mL、20.6(17.3,24.8)pg/mL、14.5(12.6,17.2)mg/L,均显著低于对照组[32.3(25.8,41.4)pg/mL、26.7(20.9,28.9)pg/mL、19.3(14.3,19.5)mg/L,P<0.05]。治疗结束,两组共出现消化道出血1例、腹腔感染5例以及电解质紊乱6例,两组并发症发生率无明显差异(P>0.05),需要重点记录的是其中1例消化道出血、2例腹腔感染未控制良好进展为重症感染的患者因病情需要进入ICU继续治疗,后病情稳定后出院。结论 DPMAS治疗DILI伴严重高胆红素血症临床疗效显著。

关键词: 药物性肝损伤, 高胆红素血症, 双重血浆分子吸附系统

Abstract: Objective To evaluate the therapeutic effect of the Dual Plasma Molecular Adsorption System(DPMAS) on drug-induced liver injury(DILI) with hyperbilirubinemia, aiming to enrich the clinical data on the diagnosis and treatment of this rare condition.Methods A total of 95 cases of DILI with hyperbilirubinemia were collected and divided into two groups: the observation group (PE+DPMAS) and the control group (PE), based on the treatment protocol. The clinical indices and their change rates were compared between the groups and across different treatment stages (pre-treatment and post-treatment).Results In terms of clinical indicators, after treatment at our center, the observation group showed significant improvements in ALT, AST, TBA, TBil and DBil, with values of 56 (35, 70) U/L, 49 (30, 73) U/L, 59.4 (43.2, 70.2) μmol/L and 102.7 (69.4, 148.7) μmol/L,and 84.5(56.8,128.7)μmol/L, respectively. In comparison, the control group had higher values:, 77 (50, 102) U/L, 71 (52, 97) U/L, 78.5 (56.2, 84.7) μmol/L, 145.9 (92.3, 206.5) μmol/L and 122.4 (78.9, 154.0) μmol/L, P<0.05. Regarding the change rate of clinical indicators, the decrease in TBA, TBil and DBil was significantly greater in the observation group than in the control group (P<0.05). For inflammatory markers, after treatment, the observation group had significantly lower levels of TNF-α, IL-6 and hs-CRP, with values of 21.6(17.5, 28.0) pg/mL, 20.6(17.3, 24.8) pg/mL and 14.5(12.6, 17.2) mg/L, respectively. These values were significantly lower than those in the control group: 32.3(25.8, 41.4) pg/mL, 26.7(20.9, 28.9) pg/mL, and 19.3(14.3, 19.5) mg/L, P<0.05]. Regarding treatment-related complications, at the end of the study, there were 1 case of gastrointestinal bleeding, 5 cases of abdominal infection, and 6 cases of electrolyte disturbance in both groups. There was no significant difference in the incidence of complications between the two groups (P>0.05). Notably, one case of gastrointestinal bleeding and two cases of abdominal infection, which were not well-controlled and progressed to severe infection, required ICU care and were later discharged after stabilization.Conclusion DPMAS is effective in treating DILI with severe hyperbilirubinemia.

Key words: Drug-induced liver injury, Hyperbilirubinemia, Dual plasma molecular adsorption system

石宏, 何剑成, 王俊杰, 杨力. 双重血浆分子吸附系统治疗药物性肝损伤伴高胆红素血症患者的临床观察[J]. 肝脏, 2024, 29(12): 1541-1544.

SHI Hong, HE Jian-cheng, WANG Jun-jie, YANG li. Clinical evaluation of the dual plasma molecular adsorption system in the treatment of drug-induced liver injury with hyperbilirubinemia[J]. Chinese Hepatolgy, 2024, 29(12): 1541-1544.

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参考文献

[1] 黄蝶, 张鑫赫, 佟静, 等. DPMAS治疗药物性肝损伤伴严重高胆红素血症患者临床疗效研究[J]. 胃肠病学和肝病学杂志, 2024, 33(2):125-128.
[2] Yim J, Hyun D, Cho SK, et al. Effect of hyperbilirubinemia on hepatic hypertrophy after portal vein embolization and liver failure after hepatectomy in primary biliary malignancy[J]. J Vasc Interv Radiol, 2019, 30(1):31-37.
[3] Gräfe C, Paal M, Winkels M, et al. Correlation between bilirubin elimination with the cytokine adsorber CytoSorb? and mortality in critically ill patients with hyperbilirubinemia[J]. Blood Purif, 2023, 52(11-12):849-856.
[4] Chen G, Wu M, Wu B, et al. Effects of dual plasma molecular adsorption system on liver function, electrolytes, inflammation, and immunity in patients with chronic severe hepatitis. J Clin Lab Anal, 2019, 33(7):e22926.
[5] 刘春涛, 武瑞, 俞海燕, 等. 双重血浆分子吸附术治疗高胆红素血症的临床研究[J]. 浙江临床医学, 2019, 21(3):341-343.
[6] Xu W, Zhu S, Yang L, et al. Safety and efficacy of double plasma molecular adsorption system with sequential low-volume plasma exchange in intermediate-stage hepatitis B virus-related acute-on-chronic liver failure[J]. J Med Virol, 2023, 95(3):e28650.
[7] Lei Y, Liang Y, Zhang X, et al. Alternating therapeutic plasma exchange (TPE) with double plasma molecular adsorption system (DPMAS) for the treatment of fulminant hepatic failure (FHF)[J]. Clin Case Rep, 2021, 9(12):e05220.
[8] 叶慧, 雷鸣, 许开亮, 等. 不同血浆吸附容积在双重血浆分子吸附系统治疗高胆红素血症中的疗效分析[J]. 中国血液净化, 2023, 22(10):730-733.
[9] 代梅, 刘霞, 陈宗倩, 等. 血浆置换联合双重血浆分子吸附系统人工肝治疗肝衰竭高胆红素血症患者疗效研究[J]. 重庆医科大学学报, 2023, 48(7):811-815.
[10] 中国医药生物技术协会药物性肝损伤防治技术专业委员会, 中华医学会肝病学分会药物性肝病学组, 茅益民. 中国药物性肝损伤诊治指南(2023年版)[J]. 胃肠病学, 2023, 28(7):397-431.
[11] Devarbhavi H, Sridhar A, Kurien SS, et al. Clinical and liver biochemistry phenotypes, and outcome in 133 patients with anti-seizure drug-induced liver injury[J]. Dig Dis Sci, 2023, 68(5):2099-2106.
[12] Yang K, Battista C, Woodhead JL, et al. Systems pharmacology modeling of drug-induced hyperbilirubinemia: Differentiating hepatotoxicity and inhibition of enzymes/transporters[J]. Clin Pharmacol Ther, 2017, 101(4):501-509.
[13] Li M, Zhang D, Yang Q, et al. Longitudinal metabolomics of human plasma reveal metabolic dynamics and predictive markers of antituberculosis drug-induced liver injury[J]. Respir Res, 2024, 25(1):254.
[14] Seal S, Williams DP, Hosseini-Gerami L, et al. Improved detection of drug-induced liver injury by integrating predicted in vivo and in vitro data[J]. Preprint BioRxiv, 2024, 2024.01.10.575128.
[15] Biswas T, Lal BB, Sood V, et al. Therapeutic plasma exchange provides native liver survival benefit in children with acute liver failure: A propensity score-matched analysis[J]. J Clin Apher, 2024, 39(3):e22130.
[16] Colak M, Ocak I. Management of pediatric liver failure with therapeutic plasma exchange and continuous renal replacement therapy: A retrospective observational study[J]. Medicine (Baltimore), 2024, 103(19):e38093.
[17] 闫国胜, 李丽丽, 姜少利, 等. 不同吸附剂在双重血浆分子吸附系统治疗肝衰竭中的临床研究[J]. 中华肝脏病杂志, 2019, 27(1):51-55.
[18] 张瑞昕, 刘立新. 单纯血浆置换或联合双重血浆分子吸附系统对肝衰竭治疗价值的Meta分析[J]. 中华肝脏病杂志, 2022, 30(10):1107-1114.
[19] Wang L, Xu W, Zhu S, et al. Double plasma molecular adsorption system with sequential low-dose plasma exchange in patients with hepatitis B virus-related acute-on-chronic liver failure: A prospective study[J]. J Clin Transl Hepatol, 2023, 11(4):908-917.