Zhou Ming, Jin Yan, Mou Yixin, Chen Zhu, Wan Bin, Mao Chuangjie, Wu Bei
Department of Hepatology, Public Health Clinical Center of Chengdu, 377, JingMing Avenue, Chengdu, 610000, SiChuan Province, China.
Department and Institute of Good Clinical Practice, Public Health Clinical Center of Chengdu, 377, JingMing Avenue, Chengdu, 610000, SiChuan Province, China.
BMC Infect Dis. 2025 Aug 30;25(1):1081. doi: 10.1186/s12879-025-11496-z.
To compare the effectiveness of plasma perfusion combined with plasma exchange (PP + PE) artificial liver support system in patients with hepatitis B virus-associated acute-on-chronic liver failure with and without HIV infection (HBV-ACLF/HIV(+) and HBV-ACLF/HIV(-), respectively) and to assess the clinical value and safety of the artificial liver support system.
This study involved 162 patients diagnosed with HBV-ACLF and hospitalized at Chengdu Public Health Clinical Medical Center from January 2020 to January 2025, in accordance with the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Acute-on-Chronic Liver Failure (2025 edition). Seventeen patients with tumors, severe underlying diseases, or other hepatitis virus infections were excluded. Patients were divided into the HBV-ACLF/HIV(+) and HBV-ACLF/HIV(-) groups. Propensity score matching (PSM) was used to correct baseline bias. Laboratory indices, Model for End-stage Liver Disease score (MELDs), and 28- and 90-day cumulative survival or mortality rates before and after artificial liver therapy were used as effectiveness indicators. Kaplan-Meier analysis was used to plot survival curves, and the log rank test was used to assess survival differences. Cox proportional hazards regression modeling was used for multifactorial analysis to further evaluate the effectiveness of PP + PE therapy and prognostic factors.
In total, 145 patients with HBV-ACLF were included, with 64 in the HBV-ACLF/HIV(+) group and 81 in the HBV-ACLF/HIV(-) group. After 1:1 PSM, 29 patients remained in each group. Alanine aminotransferase, glutamate transferase, total bilirubin, indirect bilirubin, international normalized ratio, prothrombin time activity, and MELDs significantly improved in both groups after PP + PE treatment (P < 0.05). Before and after PSM, there was no statistically significant difference in 28- or 90-day cumulative survival between the HBV-ACLF/HIV(+) and HBV-ACLF/HIV(-) groups (after PSM: log rank, P = 0.572). Multifactorial Cox regression analysis showed that improvements in total bilirubin, creatinine, leukocytes, blood ammonia, MELDs, international normalized ratio, and prothrombin time activity were associated with better short-term prognosis in patients with HBV-ACLF/HIV(+) (P < 0.005).
The PP + PE artificial liver treatment model effectively promotes liver function recovery and improves clinical status in HBV-ACLF patients, including those with HIV co-infection. This provides a valuable basis for clinical management of co-infected cases. Multicenter prospective studies are needed to confirm its long-term efficacy.
比较血浆灌流联合血浆置换（PP + PE）人工肝支持系统对合并和未合并HIV感染的乙型肝炎病毒相关性慢加急性肝衰竭患者（分别为HBV-ACLF/HIV(+)和HBV-ACLF/HIV(-)）的有效性，并评估该人工肝支持系统的临床价值和安全性。
本研究纳入了2020年1月至2025年1月在成都公共卫生临床医疗中心住院、符合《肝衰竭诊治指南（2025年版）》诊断标准的162例HBV-ACLF患者。排除17例患有肿瘤、严重基础疾病或其他肝炎病毒感染的患者。将患者分为HBV-ACLF/HIV(+)组和HBV-ACLF/HIV(-)组。采用倾向得分匹配（PSM）法校正基线偏倚。将人工肝治疗前后的实验室指标、终末期肝病模型评分（MELDs）以及28天和90天累积生存率或死亡率作为有效性指标。采用Kaplan-Meier分析绘制生存曲线，采用对数秩检验评估生存差异。采用Cox比例风险回归模型进行多因素分析，进一步评估PP + PE治疗的有效性和预后因素。
共纳入145例HBV-ACLF患者，其中HBV-ACLF/HIV(+)组64例，HBV-ACLF/HIV(-)组81例。经过1:1 PSM后，每组各有29例患者。PP + PE治疗后，两组患者的谷丙转氨酶、谷草转氨酶、总胆红素、间接胆红素、国际标准化比值、凝血酶原时间活动度和MELDs均显著改善（P < 0.05）。PSM前后，HBV-ACLF/HIV(+)组和HBV-ACLF/HIV(-)组28天或90天累积生存率无统计学差异（PSM后：对数秩，P = 0.572）。多因素Cox回归分析显示，总胆红素、肌酐、白细胞、血氨、MELDs、国际标准化比值和凝血酶原时间活动度的改善与HBV-ACLF/HIV(+)患者更好的短期预后相关（P < 0.005）。
PP + PE人工肝治疗模式可有效促进HBV-ACLF患者肝功能恢复并改善临床状态，包括合并HIV感染的患者。这为合并感染病例的临床管理提供了有价值的依据。需要多中心前瞻性研究来证实其长期疗效。
