双重血浆分子吸附系统联合血浆置换与单纯血浆置换治疗乙型肝炎相关慢加急性肝衰竭的疗效比较：一项荟萃分析。

Comparative efficacy of double plasma molecular adsorption system combined with plasma exchange versus plasma exchange in treating acute-on-chronic liver failure due to hepatitis B: A meta-analysis.

机构信息

Ningxia Medical University, Yinchuan, Ningxia, China.

Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.

出版信息

J Clin Apher. 2024 Aug;39(4):e22140. doi: 10.1002/jca.22140.

DOI:10.1002/jca.22140

PMID:39188020

Abstract

This meta-analysis aims to evaluate the effectiveness of the double plasma molecular adsorption system (DPMAS) in combination with plasma exchange (PE) compared to plasma exchange alone in the treatment of Acute-on-Chronic liver failure (LF) caused by hepatitis B. Until August 31, 2023, a comprehensive search of databases including Embase, Chinese Medical Journal Full-text Database, China Biomedical Literature Database, Wan Fang Medical Network, PubMed, and the Cochrane Library was carried out using keywords like "liver failure," "acute-on-chronic liver failure," "PE," "DPMAS," and related terms. The quality of the included studies was evaluated using QUADS (quality assessment of diagnostic accuracy studies). Software Revman 5.3 was used to examine the data, while Stata 15.1 was used to run Egger's test. Following thorough screening, 452 patients who received PE alone and 429 patients who received DPMAS in addition to PE were included. Every study that was included was of a high caliber. When comparing the DPMAS plus PE group to the PE alone group, the total bilirubin reduction was considerably higher (mean difference [MD] = -49.09, 95% confidence interval [CI]: -54.84 to -43.35, p < .00001). Prothrombin activity (PTA; MD = -1.53, 95% CI: -3.29 to -0.22, p = .09), albumin (ALB; MD = -0.58, 95% CI: -1.57 to 0.41, p = .25), prothrombin time (PT; MD = -0.07, 95% CI: -1.47 to 1.34, p = .92), and platelet count (PLT; MD = -0.08, 95% CI: -1.33 to 1.66, p = .90) did not differ significantly. The improvement in international standardized ratio (INR) was significantly greater in the PE group (MD = 0.07, 95% CI (0.03, 0.10), p = .0001). When combined with DPMAS, PE has been shown to be more effective in lowering total bilirubin levels. PE can also lower INR in individuals who have hepatitis B-related ACLF. This therapeutic strategy also lessens the need for plasma transfusions.

摘要

本荟萃分析旨在评估双重血浆分子吸附系统（DPMAS）联合血浆置换（PE）与单独 PE 相比在治疗乙型肝炎引起的慢加急性肝衰竭（LF）中的疗效。截至 2023 年 8 月 31 日，我们对包括 Embase、中国医学期刊全文数据库、中国生物医学文献数据库、万方医学网、PubMed 和 Cochrane 图书馆在内的数据库进行了全面检索，使用了“肝衰竭”、“慢加急性肝衰竭”、“PE”、“DPMAS”和相关术语等关键词。使用 QUADS（诊断准确性研究的质量评估）评估纳入研究的质量。使用 Revman 5.3 软件检查数据，使用 Stata 15.1 运行 Egger 检验。经过彻底筛选，纳入 452 例单独接受 PE 治疗的患者和 429 例接受 DPMAS 联合 PE 治疗的患者。所有纳入的研究均为高质量研究。与单独 PE 组相比，DPMAS 联合 PE 组总胆红素降低更为显著（均数差 [MD]＝-49.09，95%置信区间 [CI]：-54.84 至-43.35，p<.00001）。凝血酶原活动度（PTA；MD＝-1.53，95%CI：-3.29 至-0.22，p＝.09）、白蛋白（ALB；MD＝-0.58，95%CI：-1.57 至 0.41，p＝.25）、凝血酶原时间（PT；MD＝-0.07，95%CI：-1.47 至 1.34，p＝.92）和血小板计数（PLT；MD＝-0.08，95%CI：-1.33 至 1.66，p＝.90）无显著差异。PE 组国际标准化比值（INR）的改善显著更大（MD＝0.07，95%CI（0.03，0.10），p＝.0001）。与 DPMAS 联合使用时，PE 降低总胆红素水平的效果更显著。PE 还可以降低乙型肝炎相关 ACLF 患者的 INR。这种治疗策略还减少了对血浆输注的需求。