血浆置换联合双重血浆分子吸附系统人工肝治疗肝衰竭高胆红素血症患者疗效研究

Clinical effect of plasma exchange combined with double plasma molecular adsorption system in artificial liver support therapy for patients with liver failure and hyperbilirubinemia

摘要:

目的 探讨血浆置换（plasma exchange，PE）联合双重血浆分子吸附系统（double plasma molecular adsorption system，DPMAS）即PE+DPMAS治疗前与第1次、第2次治疗后肝衰竭高胆红素血症患者的临床疗效。方法 采用回顾性分析方法，选取2020年1月至2022年5月于遵义医科大学附属医院就诊的57名肝衰竭患者，根据采取的人工肝治疗模式不同将接受PE治疗的24例患者纳入对照组，接受PE+DPMAS的33例患者纳入实验组。收集2组治疗前与2次治疗后肝衰竭高胆红素血症患者的临床资料，观察并对比2组治疗前后肝功能、凝血功能、营养状况等指标变化情况。结果 实验组与对照组治疗前总胆红素（total bilirubin，TBil）、丙氨酸转氨酶（alanine transaminase，ALT）、天冬氨酸转氨酶（aspartate aminotransferase，AST）、球蛋白（globulin，Glb）、纤维蛋白原（fibrinogen，FIB）与第1次、第2次治疗后比较差异均有统计学意义（P<0.05），但实验组治疗比对照组治疗能更好地清除TBil、ALT、AST。2组治疗前、第1次治疗后、第2次治疗后TBil分别为（388.37±180.26） μmol/L vs. （382.37±151.39） μmol/L、（296.22±137.81） μmol/L vs. （310.76±113.57） μmol/L、（244.63±143.40） μmol/L vs. （293.91±149.77） μmol/L，差异无统计学意义（P>0.05）。实验组治疗前与2次治疗后白蛋白比较差异均无统计学意义（P>0.05），对照组比较差异均有统计学意义（P<0.05）；实验组国际标准化比率（international normalized ratio，INR）治疗前与2次治疗后比较差异无统计学意义（P>0.05），对照组比较差异有统计学意义（P<0.05）。前白蛋白、白蛋白与纤维蛋白原第1次治疗后2组比较差异均有统计学意义（P<0.05）；实验组与对照组不同治疗节点比较，TBil、血小板、Glb、ALT、AST差异均无统计学意义（P>0.05）。结论 2次PE+DPMAS治疗模式更能有效吸附和降低肝衰竭患者体内的胆红素和转氨酶，且对凝血功能、白蛋白影响小，是治疗高胆红素血症患者的有效手段。

Abstract:

Objective To investigate the clinical effect of plasma exchange（PE） combined with double plasma molecular adsorption system（DPMAS） in patients with liver failure and hyperbilirubinemia after the first and second times of treatment.Methods A retrospective analysis was performed for 57 patients with liver failure who attended our hospital from January 2020 to May 2022，and according to artificial liver support therapy，24 patients who received PE were enrolled as control group，while 33 patients who received PE+DPMAS were enrolled as experimental group. Clinical data were collected from the two groups of patients with liver failure and hyperbilirubinemia before and after two times of treatment，and the two groups were observed and compared in terms of the changes in liver function，coagulation function，nutritional status，and other indicators after treatment.Results Both the experimental group and the control group had significant changes in total bilirubin（TBil），alanine aminotransferase（ALT），aspartate aminotransferase（AST），globulin（Glb），and fibrinogen after the first and second times of treatment（P<0.05），but the experimental group showed better clearance of TBil，ALT，and AST compared with the control group，and there was no significant difference in TBil between the experimental group and the control group before treatment［（388.37±180.26） μmol/L vs. （382.37±151.39） μmol/L，P>0.05］，after the first time of treatment［（296.22±137.81） μmol/L vs. （310.76±113.57） μmol/L，P>0.05］，and after the second time of treatment［（244.63±143.40） μmol/L vs. （293.91±149.77） μmol/L，P>0.05］. There was no significant change in albumin in the experimental group before and after two times of treatment（P>0.05），while there was a significant change in albumin in the control group（P<0.05）；there was no significant change in international normalized ratio（INR） in the experimental group before and after two times of treatment（P>0.05），while there was a significant change in INR in the control group（P<0.05）. There were significant differences between the two groups in prealbumin，albumin，and fibrinogen after the first time of treatment（P<0.05），and there were no significant differences in TBil，platelet count，Glb，ALT，and AST between the experimental group and the control group at different time points of treatment（P>0.05）.Conclusion The therapeutic paradigm of PE+DPMAS for two times is more effective in adsorbing and reducing bilirubin and aminotransferases in patients with liver failure，with little impact on coagulation function and albumin，and therefore，it is an effective method for the treatment of patients with hyperbilirubinemia.