双重血浆分子吸附系统模式人工肝治疗对血小板的影响

目的: 比较双重血浆分子吸附系统(double plasma molecular absorb system, DPMAS)模式和传统血浆置换(plasma exchange, PE)模式人工肝治疗对患者血小板的影响, 评价重组人血小板生成素(recombinant human thrombopoietin, rhTPO)对此类血小板下降的临床疗效。方法: 选择2018年1月—2020年11月入住广州医科大学附属第五医院的15例DPMAS模式人工肝患者, 纳入DPMAS组, 另选择同期、年龄匹配(±5岁)广州医科大学附属第五医院接受PE的患者15例纳入PE组, 对两组患者进行回顾性分析。比较两组患者人工肝治疗前后的临床症状(如乏力、黄疸、少尿、水肿等)是否改善, 并比较两组患者治疗前后的血常规(特别是血小板)、凝血功能等指标, 记录患者治疗期间重组人血小板生成素的使用情况以及血小板的输注量。结果: DPMAS组患者临床症状改善率为86.67%, 高于PE组, 但差异无统计学意义(P>0.05), 两组患者90 d内转归情况相比, 差异无统计学意义(P>0.05), 治疗后两组白细胞、血红蛋白相比差异无统计学意义(P>0.05), 但DPMAS组患者治疗后血小板水平明显低于治疗前(P < 0.05), 且显著低于治疗后PE组(P < 0.05)。治疗后PE组患者的国际标准化比值得到明显改善(P < 0.05), 但DPMAS组患者国际标准化比值水平变化组间差异无统计学意义(P>0.05)。DPMAS组使用重组人血小板生成素平均约(8.2±3.1) 支, 住院期间输注血小板(1.5±0.3) IU, DMPAS组患者输注重组人血小板生成素后血小板明显上升。结论: 与PE模式相比, DPMAS人工肝模式可降低患者血小板水平, 应用重组人血小板生成素可刺激患者血小板再生, 提高血小板水平, 从而降低因血小板低下而发生的出血风险。

Effect of artificial liver with double plasma molecular absorb system model on patients'platelets and corresponding treatment strategy

Objective: To compare the effects of artificial liver treatment with double plasma molecular adsorption system(DPMAS) mode and traditional plasma exchange (PE) mode on platelets in patients, and to evaluate the clinical efficacy of recombinent human thrombopoietin (rhTPO) in the treatment of thrombocytopenia. Methods: A total of fifteen patients undergoing artificial liver with DPMAS model admitted to the Fifth Affiliated Hospital of Guangzhou Medical University from January 2018 to November 2020 were selected and included in the DPMAS group, and another 15 patients receiving PE were selected and included in the PE group. The improvement of clinical symptoms, such as fatigue, jaundice, oliguria, edema, etc. before and after artificial liver treatment was compared between the two groups, and the trend of blood routine (especially platelet), coagulation function and other indexes before and after treatment were compared between the two groups. The use of rhTPO and the number of platelets were recorded during treatment. Results: The improvement rate of clinical symptoms in DPMAS group was 86.67%, which was higher than that in PE group, but the difference was not statistically significant (P>0.05). There was no statistical significance in the outcome of the two groups within 90 days (P>0.05). There was no significant difference in white blood cell (WBC) and hemoglobin (HB) between the two groups after treatment (P>0.05). However, the level of platelet(PLT) in DPMAS group was significantly lower than that before treatment (P < 0.05), and was significantly lower than that in PE group (P < 0.05). After treatment, the international normalized ratio (INR) level in PE group was significantly improved (P < 0.05), but there was no significant difference in the INR level in DPMAS group (P>0.05). The patients in the DPMAS group received an average of (8.2±3.1) doses of rhTPO and (1.5±0.3) IU of platelet transfusions during hospitalization. In DMPAS group, platelets increased significantly after infusion of terbium. Conclusion: Compared with PE mode, the artificial liver with DPMAS mode can reduce platelet levels in patients, but the application of rhTPO can stimulate platelet regeneration and increase platelet levels in the patients, thereby reducing the risk of bleeding due to platelet hypoplasia.