不同模式非生物型人工肝治疗慢加急性肝衰竭的疗效

作者：赵蕊  王春美

单位：沈阳市第六人民医院 肝病科 辽宁 沈阳 110006

关键词：肝衰竭 慢加急性 血浆置换 双重血浆分子吸附 连续性肾脏替代治疗

分类号：

出版年,卷(期):页码：2025,17(4):51-56

摘要：

摘要：目的 比较不同模式非生物型人工肝治疗慢加急性肝衰竭（acute-on-chronic liver failure，ACLF）的疗效。方法 以2020年1月1日至2022年1月30日沈阳市第六 人民医院血液净化中心收治的246例接受非生物型人工肝治疗的ACLF患者为研究 对象，根据治疗方法将患者分为血浆置换（plasma exchange，PE）组（81例）、 PE联合双重血浆分子吸附系统（double plasma molecular absorb system，DPMAS） 组（85例）和PE联合DPMAS及连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）组（80例），比较3组患者治疗前和治疗4周血清总胆红素（total bilirubin，TBil）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、国际标 准化比值（international normalized ratio，INR）、白细胞介素-6（interleukin-6， IL-6）、肿瘤坏死因子-α （tumor necrosis factor-α，TNF-α）、Ｃ反应蛋白 （C-reactive protein，CRP）水平，观察不良反应并计算12周生存率。结果 PE 组、PE + DPMAS组、PE + DPMAS + CRRT组患者性别、年龄、病因、非生物型 人工肝治疗次数及并发症等差异均无统计学意义（P均＞ 0.05）。治疗前，PE组、 PE + DPMAS组、PE + DPMAS + CRRT组患者TBil [（350.214 ± 52.64）μmol/L比 （375.52 ± 89.28）μmol/L比（365.65 ± 71.34）μmol/L]、ALT [（255.24 ± 57.37）U/L比 （253.7 ± 35.95）U/L比（242.94 ± 23.34）U/L]、INR（0.76 ± 0.19比0.74 ± 0.19 比0.73 ± 0.21）、CRP [（46.25 ± 7.28）mg/L比（48.26 ± 8.85）mg/L比（47.36 ± 6.69）mg/L]、 IL-6 [（37.63 ± 11.42）ng/L比（38.45 ± 8.71）ng/L比（37.69 ± 11.93）ng/L] 及 TNF-α [（427.46 ± 52.62）mg/L比（424.31 ± 34.19）mg/L比（430.06 ± 36.53）mg/L] 水平差异均无统计学意义（P均＞ 0.05）；治疗4周后，PE组、PE + DPMAS组、 PE + DPMAS + CRRT组患者TBil [（267.42 ± 59.15）μmol/L比（232.98 ± 61.85）μmol/L 比（185.15 ± 60.88）μmol/L]、ALT [（164.72 ± 34.33）U/L比（145.09 ± 59.01）U/L 比（126.00 ± 12.31）U/L]、INR（0.67 ± 0.18比0.68 ± 0.25比0.61 ± 0.21）、CRP [（21.46 ± 7.69）mg/L比（15.36 ± 4.98）mg/L比（11.25 ± 3.16）mg/L]、IL-6 [（17.24 ± 3.25）ng/L比（12.81 ± 4.62）ng/L比（9.41 ± 2.75）ng/L] 及TNF-α [（204.76 ± 24.69）mg/L比（141.78 ± 15.52）mg/L比（104.23 ± 18.05）mg/L] 水平差 异均有统计学意义（P均 ＜ 0.05），PE + DPMAS组患者上述指标的改善效果显著优 于PE组，PE + DPMAS + CRRT组显著优于PE + DPMAS组，差异均有统计学意义 （P均 ＜ 0.05）。PE组、PE + DPMAS组、PE + DPMAS + CRRT组患者不良反 应发生率分别为13.58%（11/81）、14.12%（12/85）、13.75%（11/80），差异 无统计学意义（χ 2 = 7.400，P = 0.116），12周生存率分别为55.56%（45/81）、 64.71%（55/85）、75.00%（60/80），差异有统计学意义（χ2 = 6.699，P = 0.035）。结论 对于ACLF患者，与PE、PE + DPMAS相比，PE + DPMAS + CRRT 可降低机体炎症因子水平，稳定内环境，促进肝功能和凝血功能恢复，提高生存 率，安全性与有效性良好。

Abstract: Objective To compare the clinical efficacy of different modes of non-biological artificial liver support system in the treatments of patients with acute-on-chronic liver failure (ACLF). Methods A total of 246 patients with ACLF who received non-biological artificial liver support system therapy in Shenyang Sixth People’s Hospital from January 1st, 2020 to January 30th, 2022 were enrolled in this study. The patients were divided into plasma exchange (PE) group (81 cases), PE + double plasma molecular absorb system (DPMAS) group (85 cases) and PE + DPMAS + continuous renal replacement therapy (CRRT) group (80 cases) according to the modes of non-biological artificial liver support system. Levels of serum total bilirubin (TBil), alanine aminotransferase (ALT), international normalized ratio (INR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) of patients in three groups before and 4 weeks after treatment were compared. Additionally, adverse reactions and the 12-week survival rate were recorded. Results There were no statistically significant differences in gender, age, etiology, number of non-biological artificial liver support system therapy and complications among patients in PE group, PE + DPMAS group, and PE + DPMAS + CRRT group (all P ＞ 0.05). Before treatment, there were no statistically significant differences in the levels of TBil [(350.214 ± 52.64) μmol/L vs. (375.52 ± 89.28) μmol/L vs. (365.65 ± 71.34) μmol/L], ALT [(255.24 ± 57.37) U/L vs. (253.7 ± 35.95) U/L vs. (242.94 ± 23.34) U/L], INR (0.76 ± 0.19 vs. 0.74 ± 0.19 vs. 0.73 ± 0.21), CRP [(46.25 ± 7.28) mg/L vs. (48.26 ± 8.85) mg/L vs. (47.36 ± 6.69) mg/L], IL-6 [(37.63 ± 11.42) ng/L vs. (38.45 ± 8.71) ng/L vs. (37.69 ± 11.93) ng/L], and TNF-α [(427.46 ± 52.62) mg/L vs. (424.31 ± 34.19) mg/L vs. (430.06 ± 36.53) mg/L] among patients in PE group, PE + DPMAS group and PE + DPMAS + CRRT group (all P ＞ 0.05). Four weeks after treatment, there were statistically significant differences in the levels of TBil [(267.42 ± 59.15) μmol/L vs. (232.98 ± 61.85) μmol/L vs. (185.15 ± 60.88) μmol/L], ALT [(164.72 ± 34.33) U/L vs. (145.09 ± 59.01) U/L vs. (126.00 ± 12.31) U/L], INR (0.67 ± 0.18 vs. 0.68 ± 0.25 vs. 0.61 ± 0.21), CRP [(21.46 ± 7.69) mg/L vs. (15.36 ± 4.98) mg/L vs. (11.25 ± 3.16) mg/L], IL-6 [(17.24 ± 3.25) ng/L vs. (12.81 ± 4.62) ng/L vs. (9.41 ± 2.75) ng/L] and TNF-α [(204.76 ± 24.69) mg/L vs. (141.78 ± 15.52) mg/L vs. (104.23 ± 18.05) mg/L] among patients in PE group, PE + DPMAS group and PE + DPMAS + CRRT group (all P ＜ 0.05). The improvement of the above indicators in PE + DPMAS group was better than those in PE group, and PE + DPMAS + CRRT group was better than those in PE + DPMAS group, the differences were statistically significant (all P ＜ 0.05). The incidence of adverse reactions of patients in PE group, PE + DPMAS group and PE + DPMAS + CRRT group were 13.58% (11/81), 14.12% (12/85) and 13.75% (11/80), respectively, and the difference was not statistically significant (χ 2 = 7.400, P = 0.116). The 12-week survival rates were 55.56% (45/81), 64.71% (55/85) and 75.00% (60/80), respectively, and the difference was statistically significant (χ 2 = 6.699, P = 0.035). Conclusions For patients with ACLF, PE + DPMAS + CRRT could reduce the level of inflammatory factors, stabilize the internal environment, promote the recovery of liver function and coagulation function, improve the survival rate and the safety, and the effectiveness were good.

基金项目：

作者简介：

参考文献：

服务与反馈：

【文章下载】【加入收藏】