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摘要：
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摘要：目的 比较不同组合人工肝支持系统治疗乙型肝炎病毒相关早、中期慢加急性肝衰竭（hepatitis
B virus-related acute-on-chronic liver failure，HBV-ACLF）患者的疗效及对炎症指标的影响。方法 纳
入2019年1月至2020年1月在成都市公共卫生临床医疗中心治疗的早、中期HBV-ACLF患者167例进
行回顾性研究，根据治疗方案不同分为双重血浆分子吸附系统（double plasma molecular adsorption
system，DPMAS）联合血浆置换（plasma exchange，PE）组（DPMAS + PE组，86例）和血浆胆
红素吸附（plasma bilirubin adsorption，PBA）联合PE组（PBA + PE组，81例）。比较两组患者治
疗前后丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate
aminotransferase，AST）、总胆红素（total bilirubin，TBil）、凝血酶原时间（prothrombin time，
PT）、凝血酶原活动度（prothrombin activity，PTA）、降钙素原（procalcitonin，PCT）、C反应蛋
白（C reactive protein，CRP）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素-6
（interleukin-6，IL-6）和白细胞介素-10（interleukin-10，IL-10）等的差异，比较两组患者治疗效果
的差异。结果 治疗前两组患者的年龄、性别等基线资料差异无统计学意义（t = -0.928，P = 0.355；
χ
2
= 0.242，P = 0.623）。DPMAS + PE组和PBA + PE组患者治疗前ALT [（584.64 ± 158.33）U/L vs
（601.23 ± 176.96）U/L]、AST [（489.90 ± 136.31）U/L vs（507.57 ± 141.09）U/L]、TBil [（327.92 ±
97.01）μmol/L vs（307.19 ± 103.83）μmol/L]、PT [（27.39 ± 3.36）s vs（26.78 ± 2.94）s]和PTA
[（30.35 ± 5.08）% vs（31.19 ± 4.73）%]水平差异无统计学意义（P均＞ 0.05）。治疗后，DPMAS +
PE组患者ALT [（72.13 ± 27.37）U/L vs（88.33 ± 31.76）U/L]、AST [（52.45 ± 20.46）U/L vs（67.90 ±
24.15）U/L]和TBil [（59.71 ± 25.27）μmol/L vs（72.87 ± 29.63）μmol/L]水平显著低于PBA + PE组，
差异有统计学意义（t = -3.420、-3.087、-2.993，P = 0.001、0.003、0.003）；PT [（17.97 ±
3.53）s vs（18.30 ± 3.41）s]和PTA [（65.85 ± 21.20）% vs（61.59 ± 18.67）%]水平差异无统计学意
义（t = -0.425、0.955，P = 0.672、0.343）。与治疗前相比，两组患者治疗后ALT、AST、TBil和PT
水平均显著降低，PTA水平显著升高，差异有统计学意义（P均＜ 0.001）。治疗前，两组患者PCT
[（0.95 ± 0.42）μg/L vs（0.88 ± 0.40）μg/L]、CRP [（16.42 ± 6.04）mg/L vs（15.15 ± 5.94）mg/L]、
TNF-α [（0.026 ± 0.008）μg/L vs（0.027 ± 0.009）μg/L]、IL-6 [（79.59 ± 8.15）ng/L vs（80.57 ± 6.65）ng/L]和
IL-10 [（16.72 ± 2.46）ng/L vs（17.26 ± 2.12）ng/L]水平差异无统计学意义（P均＞ 0.05）。治疗后，
DPMAS + PE组患者PCT [（0.37 ± 0.27）μg/L vs（0.58 ± 0.25）μg/L]、CRP [（7.25 ± 4.41）mg/L vs（9.70 ±
5.57）mg/L]、TNF-α [（0.016 ± 0.004）μg/L vs（0.020 ± 0.005）μg/L]和IL-6 [（54.23 ± 9.03）ng/L vs
（62.65 ± 10.82）ng/L]水平均显著低于PBA + PE组，IL-10 [（25.01 ± 3.86）ng/L vs（22.56 ± 3.51）ng/L]
水平显著高于PBA + PE组，差异均有统计学意义（t = -3.574、-2.181、-3.258、-3.781、2.969，
P均＜ 0.05）。与治疗前相比，两组患者治疗后PCT、CRP、TNF-α、IL-6和IL-10均显著降低，差
异有统计学意义（P均＜ 0.001）。对于早期HBV-ACLF患者，DPMAS + PE组28 d好转率和12周存
活率分别为90.6%（58/64）、90.6%（58/64），均显著高于PBA + PE组的75.8%（47/62）、75.8%
（47/62），差异有统计学意义（χ
2
= 4.979、4.979，P = 0.026、0.026）；对于中期HBV-ACLF患者，
DPMAS + PE组和PBA + PE组28 d好转率[68.2%（15/22）vs 52.6%（10/19）]和12周[63.6%（14/22）vs
52.6%（10/19）]存活率差异无统计学意义（χ
2
= 1.036、0.509，P = 0.309、0.476）。结论 与PBA + PE
治疗相比，DPMAS + PE治疗有助于早、中期HBV-ACLF患者体内各种毒素和炎性介质的清除，可改
善肝功能，提高早期HBV-ACLF患者的治疗效果。
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Abstract: Objective To compare the effects of different combinations of artificial liver support system on
efficacy and inflammatory indexes of patients with hepatitis B virus-related acute-on-chronic liver failure
(HBV-ACLF) in early and middle stages. Methods A total of 167 patients with HBV-ACLF in early and
middle stages in the Public Health Clinical Center of Chengdu from January 2019 to January 2020 were
retrospectively enrolled. The patients were divided into double plasma molecular adsorption system (DPMAS)
combined with plasma exchange (PE) group (DPMAS + PE group, 86 cases) and plasma bilirubin adsorption
(PBA) combined with PE group (PBA + PE group, 81 cases) according to the therapeutic regimens. The
differences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil),
prothrombin time (PT), prothrombin activity (PTA), procalcitonin (PCT), C reactive protein (CRP), tumor
necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels of patients between the
two groups were compared. The therapeutic effects were also compared. Results There were no statistically
significant differences in the baseline characteristics such as age and gender of patients between the two
groups (t = -0.928, P = 0.355; χ
2
= 0.242, P = 0.623). There were no statistically significant differences in ALT
[(584.64 ± 158.33) U/L vs (601.23 ± 176.96) U/L], AST [(489.90 ± 136.31) U/L vs (507.57 ± 141.09) U/L], TBil
[(327.92 ± 97.01) μmol/L vs (307.19 ± 103.83) μmol/L], PT [(27.39 ± 3.36) s vs (26.78 ± 2.94) s] and PTA
[(30.35 ± 5.08)% vs (31.19 ± 4.73)%] levels of patients between DPMAS + PE group and PBA + PE group
before treatment (all P ＞ 0.05). After treatment, the ALT [(72.13 ± 27.37) U/L vs (88.33 ± 31.76) U/L],
AST [(52.45 ± 20.46) U/L vs (67.90 ± 24.15) U/L] and TBil [(59.71 ± 25.27) μmol/L vs (72.87 ± 29.63) μmol/L] levels
of patients in DPMAS + PE group were significantly lower than those of PBA + PE group, the differences
were statistically significant (t = -3.420, -3.087, -2.993; P = 0.001, 0.003, 0.003), and there were no significant
differences in PT [(17.97 ± 3.53) s vs (18.30 ± 3.41) s] and PTA [(65.85 ± 21.20)% vs (61.59 ± 18.67)%]
levels of patients between the two groups (t = -0.425, 0.955; P = 0.672, 0.343). Compared with before treatment,
the ALT, AST, TBil and PT levels decreased significantly and PTA level increased significantly of patients
in both groups after treatment, the differences were statistically significant (all P ＜ 0.001). There were no
statistically significant differences in PCT [(0.95 ± 0.42) μg/L vs (0.88 ± 0.40) μg/L], CRP [(16.42 ± 6.04) mg/L vs
(15.15 ± 5.94) mg/L], TNF-α [(0.026 ± 0.008) μg/L vs (0.027 ± 0.009) μg/L], IL-6 [(79.59 ± 8.15) ng/L vs (80.57 ±
6.65) ng/L] and IL-10 [(16.72 ± 2.46) ng/L vs (17.26 ± 2.12) ng/L] levels of patients between DPMAS + PE
group and PBA + PE group before treatment (all P ＞ 0.05). After treatment, the PCT [(0.37 ± 0.27) μg/L vs
(0.58 ± 0.25) μg/L], CRP [(7.25 ± 4.41) mg/L vs (9.70 ± 5.57) mg/L], TNF-α [(0.016 ± 0.004) μg/L vs (0.020 ±
0.005) μg/L and IL-6 [(54.23 ± 9.03) ng/L vs (62.65 ± 10.82) ng/L] levels of patients in DPMAS + PE group were
significantly lower than those of PBA + PE group, and the IL-10 [(25.01 ± 3.86) ng/L vs (22.56 ± 3.51) ng/L] level
of patients in DPMAS + PE group was significantly higher than that of PBA + PE group, the differences were
statistically significant (all P ＜ 0.05). Compared with before treatment, the PCT, CRP, TNF-α, IL-6 and IL10 levels of patients in both groups decreased significantly after treatment, the differences were statistically
significant (all P ＜ 0.001). For patients with HBV-ACLF in early stage, the improvement rate in 28 days and
survival rate in 12 weeks in DPMAS + PE group were 90.6% (58/64) and 90.6% (58/64), respectively, which
were significantly higher than those in PBA + PE group [75.8% (47/62), 75.8% (47/62)], the differences were
statistically significant (χ
2
= 4.979, 4.979; P = 0.026, 0.026). For patients with HBV-ACLF in middle stage,
there were no significant differences in the improvement rate in 28 days [68.2% (15/22) vs 52.6% (10/19)]
and survival rate in 12 weeks [63.6% (14/22) vs 52.6% (10/19)] between DPMAS + PE group and PBA + PE
group (χ
2
= 1.036, 0.509; P = 0.309, 0.476). Conclusions Compared with PBA + PE, DPMAS + PE is more
helpful for the clearance of toxins and inflammatory cytokines, and can improve the liver function of patients
with HBV-ACLF in early and middle stages and improve the therapeutic effect of patients with HBV-ACLF
in early stage.
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