Zhong S, Wang N, Zhao J, Zhang L, Luo L, Zeng W Q, Shi X F, Wang Z Y, Cai D C, Zhang D Z, Zhou Z, Hu P
Department of Infectious Diseases, the Second Affiliated Hospital, Chongqing Medical University; Viral Hepatitis Research Department, Chongqing Medical University; Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education and Department of Infectious Disease, Chongqing Medical University, Chongqing 400010, China.
Zhonghua Gan Zang Bing Za Zhi. 2018 Oct 20;26(10):744-749. doi: 10.3760/cma.j.issn.1007-3418.2018.10.003.
To compare the efficacy and safety of plasma exchange (PE) combined with double plasma absorption and simple PE in the treatment of acute-on-chronic liver failure. We retrospectively analyzed 251 cases of acute-on-chronic liver failure treated with artificial liver treatment since January 2015. Changes in clinical manifestations, laboratory tests, and complications of the patients before and after different modes of treatment were compared and short-term efficacy was tracked. In accordance with different data, t-test, Pearson's chi-squared test and Fisher's exact test were used for statistical analysis. The effectiveness of low-volume PE combined with double plasma molecular adsorption system (DPMAS) and equal amount of PE combined with DPMAS was significantly better than simple PE (83.7%, 84.05% and 82.15 vs 55.6%, < 0.05) in early stage of liver failure. In late-stage of liver failure, there was no significant difference in the treatment efficiency of each group ( > 0.05). Bilirubin and bile acid levels were significantly decreased in combined treatment groups than that to simple PE group ( < 0.05). PTA and albumin improvement rate of DPMAS PE groups were significantly lower than that of simple PE group ( < 0.05). There was no statistical difference in adverse reactions between each group. PE combined with DPMAS improves the treatment efficiency of early hepatic failure and decrease dosage of plasma when compared with simple PE. A beforehand DPMAS treatment after PE treatment can improve the adverse effects of DPMAS on blood coagulation function and albumin levels.
比较血浆置换（PE）联合双重血浆吸附与单纯PE治疗慢加急性肝衰竭的疗效及安全性。回顾性分析2015年1月以来接受人工肝治疗的251例慢加急性肝衰竭患者。比较不同治疗方式前后患者的临床表现、实验室检查及并发症变化，并追踪短期疗效。根据不同数据，采用t检验、Pearson卡方检验和Fisher确切检验进行统计分析。在肝衰竭早期，小剂量PE联合双重血浆分子吸附系统（DPMAS）及等量PE联合DPMAS的疗效显著优于单纯PE（83.7%、84.05%和82.15% vs 55.6%，<0.05）。在肝衰竭晚期，各组治疗效率无显著差异（>0.05）。联合治疗组胆红素和胆汁酸水平较单纯PE组显著降低（<0.05）。DPMAS-PE组的PTA和白蛋白改善率显著低于单纯PE组（<0.05）。各组不良反应无统计学差异。与单纯PE相比，PE联合DPMAS可提高早期肝衰竭的治疗效率并减少血浆用量。PE治疗后先行DPMAS治疗可改善DPMAS对凝血功能和白蛋白水平的不良影响。
