Ma Yuanji, Xu Yan, Du Lingyao, Bai Lang, Tang Hong
Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 GuoXue Xiang, Wuhou District, Chengdu, 610041, China.
Eur J Med Res. 2025 Mar 15;30(1):175. doi: 10.1186/s40001-025-02419-4.
The double plasma molecular adsorption system (DPMAS) is a crucial therapeutic modality for the management of severe liver disease. Current literature reports considerable variability in the volume of processed plasma (VPP) utilized during DPMAS treatment, and there is currently no consensus on the appropriate VPP. We aimed to investigate the relationship between VPP and changes in total bilirubin levels during DPMAS treatment.
A prospective observational study with a repeated-measures design was conducted in patients with severe liver disease. The generalized estimation equations were used to evaluate the relationship between VPP and changes in total bilirubin levels during DPMAS treatment. The Bonferroni method was used for multiple comparisons. Tests for linear trends were performed by entering the median value of each category as a continuous variable. Total bilirubin level were detected repeatedly at four different times (four different VPP) (at 0.0 h (0 mL); at 2.0 h (3000 mL); at 2.5 h (3750 mL); at 3.0 h (4500 mL)).
Twenty-nine patients who underwent 75 sessions of DPMAS treatment were enrolled. The baseline total bilirubin levels and model for end-stage liver disease score were 426.1 (356.6-487.3) μmol/L and 21.9 (18.7-24.9). The total bilirubin levels and their reduction ratios in all patients (75 sessions) or patients with total bilirubin <425 μmol/L (39 sessions) or ≥425 μmol/L (36 sessions) decreased gradually and significantly at four different times (four different VPP) (all adjusted P for pairwise comparisons <0.001; adjusted P for trend <0.001). The reduction ratios of total bilirubin in patients with total bilirubin ≥425 μmol/L were similar to those with total bilirubin <425 μmol/L (adjusted OR (95% CI), 1.001 (0.966-1.036)). The positive relationship between the reduction ratios of total bilirubin and VPP was less remarkable in patients with higher height (adjusted P for interaction = 0.027) or lower albumin levels (adjusted P for interaction = 0.017).
The VPP of DPMAS treatment could be more than 4500 mL. Patients with higher height or lower albumin levels might require a higher VPP to achieve sufficient therapeutic efficacy.
双重血浆分子吸附系统（DPMAS）是治疗严重肝病的关键治疗方式。当前文献报道，DPMAS治疗期间使用的处理后血浆量（VPP）存在很大差异，目前对于合适的VPP尚无共识。我们旨在研究DPMAS治疗期间VPP与总胆红素水平变化之间的关系。
对严重肝病患者进行了一项采用重复测量设计的前瞻性观察研究。使用广义估计方程来评估DPMAS治疗期间VPP与总胆红素水平变化之间的关系。采用Bonferroni方法进行多重比较。通过将每个类别的中位数作为连续变量来进行线性趋势检验。在四个不同时间（四个不同的VPP）重复检测总胆红素水平（0.0小时（0毫升）；2.0小时（3000毫升）；2.5小时（3750毫升）；3.0小时（4500毫升））。
纳入了29例接受75次DPMAS治疗的患者。基线总胆红素水平和终末期肝病模型评分分别为426.1（356.6 - 487.3）μmol/L和21.9（18.7 - 24.9）。所有患者（75次治疗）或总胆红素<425 μmol/L的患者（39次治疗）或≥425 μmol/L的患者（36次治疗）的总胆红素水平及其降低率在四个不同时间（四个不同的VPP）均逐渐且显著下降（所有两两比较的校正P<0.001；趋势校正P<0.001）。总胆红素≥425 μmol/L的患者与总胆红素<425 μmol/L的患者的总胆红素降低率相似（校正OR（95%CI），1.001（0.966 - 1.036））。在身高较高（交互作用校正P = 0.027）或白蛋白水平较低（交互作用校正P = 0.017）的患者中，总胆红素降低率与VPP之间的正相关关系不太显著。
DPMAS治疗的VPP可以超过4500毫升。身高较高或白蛋白水平较低的患者可能需要更高的VPP才能达到足够的治疗效果。
