Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China.
Gastroenterology Department of Second Affiliated Hospital of Kunming Medical University, Kunming, China.
J Int Med Res. 2020 Jun;48(6):300060520932053. doi: 10.1177/0300060520932053.
Our objective was to compare the effectiveness of nonbiological artificial liver (NBAL) support, particularly short-term (28-day) survival rates, in patients who underwent treatment using double plasma molecular adsorption system (DPMAS), plasma exchange (PE), or combined PE+DPMAS, in addition to comprehensive physical treatment for different stages of acute-on-chronic liver failure (ACLF).
We retrospectively reviewed clinical data of 135 patients with ACLF who received NBAL treatment between November 2015 and February 2019. The patients were categorized into PE, DPMAS, and PE+DPMAS groups. Short-term effectiveness of treatment was assessed and compared based on selected clinical findings, laboratory parameters, and liver function markers.
Coagulation function improved significantly in all groups after treatment. In the PE and PE+DPMAS groups, prothrombin time decreased to different degrees, whereas plasma thromboplastin antecedent increased significantly after treatment. White blood cell counts increased and platelet counts decreased in all groups after treatment. The model for end-stage liver disease score, Child-Pugh grade, systematic inflammatory syndrome score, and sepsis-related organ failure score decreased in all three groups after treatment.
PE, DPMAS, and PE+DPMAS improved disease indicators in all patients with ACLF. The combined treatment improved the short-term effectiveness of treatment, especially in patients with mild ACLF.
本研究旨在比较双重血浆分子吸附系统（DPMAS）、血浆置换（PE）和联合 PE+DPMAS 三种非生物型人工肝（NBAL）治疗方案在不同分期慢加急性肝衰竭（ACLF）患者中的疗效，尤其是 28 天短期生存率。
回顾性分析 2015 年 11 月至 2019 年 2 月期间 135 例接受 NBAL 治疗的 ACLF 患者的临床资料。将患者分为 PE 组、DPMAS 组和 PE+DPMAS 组。根据患者的临床指标、实验室参数和肝功能标志物，评估并比较各组患者的短期治疗效果。
三组患者治疗后凝血功能均明显改善，PE 组和 PE+DPMAS 组凝血酶原时间均有不同程度下降，DPMAS 组和 PE+DPMAS 组血浆凝血酶原时间前体明显升高；三组患者白细胞计数均升高，血小板计数均降低。三组患者的终末期肝病模型评分、Child-Pugh 分级、全身炎症反应综合征评分和脓毒症相关器官衰竭评分均较治疗前降低。
PE、DPMAS 和 PE+DPMAS 均可改善 ACLF 患者的病情指标。联合治疗可提高治疗的短期疗效，尤其对轻度 ACLF 患者更为有效。
