关键词: 双重血浆分子吸附, 血浆置换, 高胆红素血症, 吲哚菁绿15分钟清除率, 短期预后

Abstract: Objective To analyze the efficacy of double plasma molecular adsorption system (DPMAS) combined with plasma exchange (PE) in the treatment of hyperbilirubinemia, and clarify the short-term prognostic evaluation efficacy of indocyanine green 15-minute clearance rate(ICGR15). Methods A total of 40 patients with hyperbilirubinemia admitted to Xiamen Humanity Hospital from 2022 to 2025 were selected. Based on their clinical outcomes 12 weeks after admission, they were divided into an improved group (28 cases) and a non-healed group (12 cases). All patients received comprehensive internal medicine treatment plus DPMAS combined with PE. Liver function, coagulation function, and ICGR15 were detected before and after treatment, and a 12-week follow-up was conducted. Results The TBil before treatment and after treatment was (326.5 ± 89.7)μmol/L and (158.3 ± 45.2)μmol/L, respectively (t=16.732, P<0.001); the DBil before treatment and after treatment was (215.6±67.3)μmol/L and (98.7±32.1)μmol/L, respectively (t=16.934,P<0.001); the GGT before treatment and after treatment was (389.4±102.6)IU/L and (198.5±56.3)IU/L, respectively (t=17.737,P<0.001); the PⅢP before treatment and after treatment was (218.7±45.3)ng/mL and (135.4±32.1)ng/mL, respectively (t=18.132,P<0.001); the PTA before treatment and after treatment was (42.3±8.7)% and (65.4±10.3)%, respectively (t=19.325,P<0.001). After treatment, the patients' liver function, coagulation function, and liver fibrosis-related indicators all showed improvement. Before treatment, the ICGR15 of the improved group and the non-healed group was (38.7±6.3)% and (39.1±5.8)%, respectively (t=0.212, P=0.834); after treatment, the ICGR15 of the improved group and the non-healed group was (15.42±4.1)% and (23.56±5.2)%, respectively (t=5.872,P<0.001). The reduction in ICGR15 was greater in the improved group compared to the non-healed group. The AUC of ICGR15 for predicting short-term prognosis reached 0.786(95% CI:0.621～0.912), with an optimal cut-off value of 18.5%, sensitivity and specificity of 77.3% and 75.0%, respectively. The incidence of adverse reactions was 16.7%, which resolved after symptomatic treatment without interrupting the treatment process. Conclusion The combination of DPMAS and PE has a definite therapeutic effect and good safety for hyperbilirubinemia. ICGR15 can reliably evaluate the treatment effect and short-term prognosis, and the combination of the two provides a new basis for precise diagnosis and treatment of the disease.

Key words: Double plasma molecular adsorption system, Plasma exchange, Hyperbilirubinemia, Indocyanine green clearance rate in 15 minutes, Short-term prognosis