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

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.