血浆置换序贯双重血浆分子吸附系统治疗慢加急性乙型肝炎肝衰竭患者疗效研究*

目的 探讨血浆置换(PE)序贯双重血浆分子吸附系统(DPMAS)治疗慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者的疗效。方法 2018年5月～2020年5月诊治的64例HBV-ACLF患者,其中33例接受PE治疗,31例接受PE序贯DPMAS治疗,观察90 d疗效。应用Kaplan-Meier法进行生存分析。结果 在治疗28 d和90 d,序贯组血清总胆红素水平为(119.5±19.4)μmol/L和(29.5±10.4)μmol/L,显著低于PE组【分别为(149.5±30.5)μmol/L和(52.4±15.9)μmol/L,P＜0.05】;在治疗90 d,序贯组血清C-反应蛋白、降钙素原和白细胞介素(IL)-6水平分别为(12.6±3.5)mg/L、(0.5±0.2)ng/L和(13.4±2.7)ng/L,显著低于对照组【分别为(19.2±3.3)mg/L、(0.7±0.4)ng/L和(18.2±3.5)ng/L,P＜0.05】;在治疗90 d,序贯组生存26例(83.9%),PE组生存19例(57.6%),经Kaplan-Meier法分析,差异显著(P＜0.05)。结论 应用血浆置换序贯双重血浆分子吸附系统治疗HBV-ACLF患者可改善肝功能,清除血清炎症因子,提高短期生存率。

Short-term efficacy of sequential plasma exchange and dual plasma molecular adsorption system combination in treatment of patients with HBV-ACLF

Objective The aim of this study was to investigate the short-term efficacy of sequential plasma exchange (PE) and dual plasma molecular adsorption system (DPMAS) combination in treatment of patients with hepatitis B virus infection-related acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed on the clinical data of 64 patients with HBV-ACLF admitted to First Affiliated Hospital, Army Medical University and the 923rd Hospital, People's Liberation Army, between May 2018 and May 2020. Out of them, 33 patients received PE and 31 patients received PE and sequential DPMAS treatment. All patients were follow-up for 90 days. The survival rates in the two groups were statistically analyzed by Kaplan-Meier method. Results At the end of day 28 and day 90, total serum bilirubin levels in PE-DPMAS-treated patients were (119.5±19.4)μmol/L and (29.5±10.4)μmol/L, significantly lower than (149.5±30.5)μmol/L and (52.4±15.9)μmol/L, respectively, P＜0.05] in patients receiving PE; at the end of 90 day treatment, serum c-reactive protein, procalcitonin and interleukin-6 levels were(12.6±3.5)mg/L,(0.5±0.2)ng/L and (13.4±2.7)ng/L, significantly lower than (19.2±3.3)mg/L, (0.7±0.4)ng/L and (18.2±3.5)ng/L, respectively, P＜0.05] in patients receiving PE alone; at the end of 90 days, the survival rate in patients receiving PE-DPMAS treatment was 83.9%, significantly higher than 57.6% in PE-treated patients (P＜0.05). Conclusion The sequential therapy with PE and DPMAS could improve liver function tests, decrease serum inflammatory factors and elevate the 90 day survivals in patients with HBV-ACLF.