Abstract:Objective: To explore the guiding significance of model for end-stage liver disease (MELD) score in patients with hepatitis B virus (HBV) -related liver failure choosing different ways of artificial liver: plasma exchange (PE), double plasma molecular adsorption system (DPMAS) and PE+DPMAS. Methods: The clinical data of 210 patients with HBV-related liver failure were analyzed retrospectively. All patients were divided into three intervals according to the MELD value at admission: MELD<30, 30≤MELD<40 and MELD≥40.Patients in each interval were divided into three groups according to different ways of artificial liver: the PE group, the DPMAS group and the PE+DPMAS group. Changes of laboratory indexes, MELD score, 4-week effective rate and 12-week mortality rate before and after treatment in three MELD groups were compared. Results: ①In all MELD intervals, the ALT, AST, TBIL and MELD scores in three groups before and after treatment were significantly decreased (P<0.05). Only in the 30≤MELD<40 interval, the decrease rate of TBIL and MELD decrease in the PE+DPMAS group were was the highest, with statistical difference (P<0.01), while there was no significant difference between intergroups in the other two MELD intervals.②In all MELD intervals, the PTA in the PE+DPMAS group and the PE group was increased and the difference between two groups was not statistically significant. PTA in the DPMAS group was decreased, with statistical significance (P<0.01). ③In all MELD intervals, there was no significant change in creatinine (Cr) before and after treatment, with no significant difference among three groups (P>0.05). ④In the MELD<30 interval, the efficiency of 4-week among three groups was not statistically significant (P>0.05), and PE group had the highest mortality at 12 week (P<0.05). In the 30≤MELD<40 interval, the PE+DPMAS group had the highest efficiency (P<0.05) and the lowest case fatality (P<0.01), and the difference was statistically significant; in the MELD≥40 interval, there was no significant difference among three groups in the efficiency and mortality (P>0.05). Conclusion: MELD score can be used for choosing artificial liver in patients with HBV-related liver failure. Patients in MELD<30 interval, prefer to DPMAS, while patients with liver failure in 30≤MELD<40 interval prefer to PE+DPMAS. But for patients in MELD≥40 interval, all artificial liver treatment are poor, therefore, liver transplantation should be performed as soon as possible.
