双重血浆分子吸附序贯血浆置换嵌合血液透析滤过治疗肝衰竭合并肾功能不全的疗效及安全性

肝脏 ›› 2025, Vol. 30 ›› Issue (10): 1398-1401.

双重血浆分子吸附序贯血浆置换嵌合血液透析滤过治疗肝衰竭合并肾功能不全的疗效及安全性

王悦宁, 周莉, 邹怀宾, 陈煜

100069 北京首都医科大学附属北京佑安医院肝病中心四科

收稿日期:2024-10-20 出版日期:2025-10-31 发布日期:2025-12-16
通讯作者: 陈煜,Email:chybeyond1071@ccmu.edu.cn
基金资助:
北京市医院管理中心“登峰”人才培养计划(DFL20221501);高层次公共卫生技术人才培养计划(2022-2-012);北京市科技新星计划(20220484201);北京自然科学基金项目(7232081);北京肝胆相关公益基金会人工肝专项基金(RGGTT-2021-043)

Efficacy and safety analysis of double plasma molecular adsorption system sequential plasma exchange and hemodiafiltration in the treatment of patients with liver failure complicated with renal insufficiency

WANG Yue-ning,ZHOU Li,ZOU Huai-bin, CHEN Yu

Fourth Department of Liver Disease, Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China

Received:2024-10-20 Online:2025-10-31 Published:2025-12-16
Contact: CHEN Yu,Email:chybeyond1071@ccmu.edu.cn

摘要/Abstract

摘要： 目的探讨双重血浆分子吸附(DPMAS)序贯血浆置换(PE)嵌合血液透析滤过(HDF)治疗肝衰竭合并肾功能不全患者的疗效及安全性。方法纳入2022年9月至2023年6月首都医科大学附属北京佑安医院收治的肝衰竭合并肾功能不全患者27例,共行DPMAS序贯PE嵌合HDF治疗34例次,分析治疗前后患者的肝功能、肾功能、凝血功能、终末期肝病模型(MELD)评分等变化情况及其疗效。结果 27例患者12周存活23例,其中接受肝移植5例,非肝移植存活率66.7%(18/27)。治疗后即刻TBil(286.60±127.39)μmol/L、DBil(194.32±80.75)μmol/L、BUN(10.51±8.26)mmol/L、CREA(143.29±111.74)μmol/L、eGFR(75.98±45.21)及MELD评分(26.66±8.83)分与治疗前TBil(472.60±191.34)μmol/L、DBil(317.80±125.49)μmol/L、BUN(13.56±10.39)mmol/L、CREA(172.65±131.07)μmol/L、eGFR(66.43±43.80)mL/min及MELD评分(31.6±8.9)分相比,差异均有统计学意义(P<0.05),治疗后24 h、72 h的TBil、DBil及治疗后24 h的BUN较治疗前明显下降(P<0.05),治疗后24 h、72 h的BUN、CREA、eGFR及MELD评分与治疗前相比差异无统计学意义(P>0.05)。治疗后24 h、72 h的总蛋白、白蛋白、球蛋白以及治疗后即刻、24 h、72 h凝血酶原活动度、国际标准化比值较治疗前差异均无统计学意义(P>0.05)。结论 DPMAS序贯PE嵌合HDF治疗肝衰竭合并肾功能不全患者安全性良好,且在短期内能有效降低血清胆红素水平、改善肝、肾功能及预后指标,可作为肝衰竭合并肾功能不全患者肝移植前的过渡手段。

关键词: 人工肝, 肝功能衰竭, 双重血浆分子吸附, 血浆置换, 血液透析滤过

Abstract: Objective To investigate the efficacy and safety of double plasma molecular adsorption system (DPMAS) sequential plasma exchange (PE) and hemodiafiltration (HDF) in patients with liver failure complicated with renal insufficiency. Methods A retrospective analysis was conducted on 27 patients with liver failure and renal insufficiency admitted to Beijing YouAn Hospital affiliated to Capital Medical University from September 2022 to June 2023. A total of 34 patients were treated with DPMAS sequential PE and HDF. The changes in liver function, renal function, coagulation function and model for end-stage liver disease (MELD) score before and after treatment were statistically analyzed to study the short-term efficacy and safety of the combination of DPMAS sequential PE and HDF. Results The hemodynamics remained stable during the 34 treatments, all of which were successfully completed. After 12 weeks, 23 patients survived (including 5 who underwent liver transplantation), while 4 died, resulting in a non-liver transplant survival rate of 66.7% (18/27). Immediately after treatment, the indexes such as TBil(286.60±127.39)μmol/L、DBil(194.32±80.75)μmol/L,BUN(10.51±8.26)mmol/L、CREA(143.29±111.74)μmol/L、eGFR(75.98±45.21)mL/min and MELD scores(26.66±8.83) significantly decreased (P<0.05) compared to pre-treatment levels:TBil(472.60±191.34)μmol/L、DBil(317.80±125.49)μmol/L,BUN(13.56±10.39)mmol/L、CREA(172.65±131.07)μmol/L、eGFR(66.43±43.80)mL/min and MELD scores(31.6±8.9). TBil and DBil levels 24 and 72 hours post-treatment and BUN 24 hours post-treatment also significantly decreased (P<0.05). There was no significant difference in BUN, CREA, eGFR, and MELD scores at 24 and 72 hours post-treatment compared to pre-treatment (P>0.05). There was no significant change in total protein, albumin, globulin, immediately after treatment and prothrombin activity, international normalized ratio immediately after, 24 hours, and 72 hours post-treatment compared to pre-treatment (P>0.05). Conclusion The combination of DPMAS sequential PE and HDF therapy is safe for patients with liver failure complicated with renal insufficiency. This combination of artificial liver can also effectively reduce serum bilirubin levels, improve organ function and prognosis indicators in the short term. It can be used as a transitional measure before liver transplantation for patients with liver failure and renal insufficiency.

Key words: Artificial liver support system, Liver failure, Double plasma molecular adsorption, Plasma exchange, hemodiafiltration

王悦宁, 周莉, 邹怀宾, 陈煜. 双重血浆分子吸附序贯血浆置换嵌合血液透析滤过治疗肝衰竭合并肾功能不全的疗效及安全性[J]. 肝脏, 2025, 30(10): 1398-1401.

WANG Yue-ning,ZHOU Li,ZOU Huai-bin, CHEN Yu. Efficacy and safety analysis of double plasma molecular adsorption system sequential plasma exchange and hemodiafiltration in the treatment of patients with liver failure complicated with renal insufficiency[J]. Chinese Hepatolgy, 2025, 30(10): 1398-1401.

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