Clinical efficacy of DPMAS combined with PE in the treatment of liver failure

Abstract

Abstract: Objective To study the curative effect of double plasma molecular adsorption system (DPMAS) combined with plasma exchange (PE) on patients with liver failure. Methods A total of 138 patients with liver failure from October 2018 to May 2022 were enrolled. The patients were randomly divided into DPMAS group(Group A), PE group(Group B) and DPMAS+ PEgroup(Group C) with 46 cases in each group. The changes of liver function indexes (AST, ALT, TBil), the serum cytokines (TNF-α, IFN-γ and IL-6) and coagulation function (PT, INR, PTA) in the 3 groups were collected. Results On the 90th day of treatment, managment in Group C was assessed as markedly effective in 22 cases, effective in 14 cases and ineffective in 3 cases. 7 cases died during the treatment. The intervention outcomes for Group C outperformed those of both Group A(which had 12 effective cases, 19 effective cases, 3 ineffective cases and 12 deaths) and Group B(which had 11 effective cases, 18 effective cases, 3 ineffective cases, 14 deaths) (Z=-2.044, -2.408; P=0.041, 0.016). On the 28th and 90th of treatment, the levels of TBil in Group B[(201.1±77.4) μmol/L and (93.6±28.2) μmol/L, respectively] were significantly higher than those in Group A [(157.9±56.2) μmol/L and (80.2±21.7) μmol/L] and Group C [(162.7±50.2) μmol/L and (78.6±24.6) μmol/L, F=6.630、5.004,P=0.002、0.008]. On the 90th day of treatment, the serum levels of TNF-α, IFN-γ and IL-6 in Group C[(20.6±14.4) pg/mL, (32.4±13.8) pg/mL and (31.7±10.1) ng/L, respectively] were significantly lower than those in group A [(34.2±16.2) pg/mL, (43.2±18.4) pg/mL and (48.7±14.4) ng/L] and group B [(35.7±17.3) pg/mL, (40.6±17.6) pg/mL and (50.0±12.8) ng/L]. F=12.417、5.228、30.406,all P<0.05]. On the 90th day of treatment, PT and INR in Group A[(18.3±3.8) s and (1.23±0.11), respectively] were significantly higher than those in Group B [(15.1±3.6) s and (1.10±0.09)] and Group C [(14.6±3.9) s and (1.07±0.27), F=13.052、10.722,P=0.000、0.000]. Conclusion The DPMAS sequential PE therapy for patients with liver failure effectively leverages the strengths of both DPMAS and PE. It is capable of clearing cytokines, improving coagulation disorder, safeguarding liver function and thereby enhancning the overal therapeutic efficacy.

Key words: Hepatic failure, Double plasma molecular adsorption system, Plasma exchange, Cytokines, Liver function

YANG Hang, LUO Yong-yan, PAN Lu-da, ZHANG Lue-tao, SONG Su-na. Clinical efficacy of DPMAS combined with PE in the treatment of liver failure[J]. Chinese Hepatolgy, 2023, 28(6): 707-710.

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