摘要
目的探讨不同人工肝组合模式对肝衰竭的治疗作用及安全性。方法回顾性分析2023年8月至2025年1月接受非生物型人工肝技术(NBAL)治疗的90例肝衰竭患者的临床资料,按照治疗方案分为血浆置换(PE)组、双重血浆分子吸附系统(DPMAS)组、1/2PE+DPMAS组,每组30例。比较三组治疗效果、生存率及凝血指标、病情评分、肝功能指标、血常规指标。结果1/2PE+DPMAS组早期有效率及28 d生存率均高于PE组、DPMAS组(P<0.05);三组中期、晚期的有效率及28 d生存率比较,差异无显著性(P>0.05)。治疗后三组凝血酶原时间(PT)、国际标准化比值(INR)降低,1/2PE+DPMAS组PT高于PE组,低于DPMAS组;1/2PE+DPMAS组INR低于DPMAS组(P<0.05)。治疗后三组Child-Pugh分级、终末期肝病模型(MELD)评分降低,1/2PE+DPMAS组Child-Pugh分级评分低于PE组及DPMAS组(P均<0.05)。治疗后三组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)水平均降低,1/2PE+DPMAS组、DPMAS组ALP水平下降幅度低于PE组(P均<0.05)。治疗后,三组白细胞计数(WBC)升高,血小板计数(PLT)、血红蛋白(Hb)降低(P<0.05);但三组间WBC、PLT、Hb比较,差异无显著性(P>0.05)。结论1/2PE+DPMAS、PE、DPMAS三种组合方式治疗肝衰竭均可改善患者肝功能、凝血功能,但1/2PE+DPMAS在改善早期肝衰竭患者的短期有效率及生存率方面效果更加突出。
Objective To explore the therapeutic effects and safety of different artificial liver combination modes in the treatment of liver failure.Methods The clinical data of 90 patients with liver failure who received non-biological artificial liver technique(NBAL)treatment from August 2023 to January 2025 were retrospectively analyzed and were divided into plasma exchange(PE)group,dual plasma molecular adsorption system(DPMAS)group,and 1/2 PE+DPMAS group according to the treatment plan,with 30 cases in each group.The therapeutic effects,survival rates,coagulation indicators,disease scores,liver function indicators,and blood routine indicators of the three groups were compared.Results The early effective rate and 28-day survival rate in the 1/2PE+DPMAS group were higher than those in the PE group and the DPMAS group(P<0.05);no significant difference showed in the effective rate and 28-day survival rate between the three groups at the mid-term and late-term stages(P>0.05).After treatment,PT and INR levels decreased in all three groups.The PT level in the 1/2PE+DPMAS group was higher than that in the PE group but lower than that in the DPMAS group;the INR level in the 1/2PE+DPMAS group was lower than that in the DPMAS group(P<0.05).After treatment,the Child-Pugh classification and MELD scores in all three groups decreased,and the Child-Pugh classification score in the 1/2PE+DPMAS group was lower than that in the PE group and the DPMAS group(all P<0.05).After treatment,the levels of ALT,AST,ALP and GGT in all three groups decreased.The decrease in ALP levels in the 1/2PE+DPMAS group and the DPMAS group was lower than that in the PE group(all P<0.05).After treatment,WBC levels in all three groups increased,while PLT and Hb levels decreased(P<0.05);but no significant difference was found in WBC,PLT and Hb levels among the three groups(P>0.05).Conclusions All three treatment regimens of 1/2PE+DPMAS,PE,and DPMAS can improve liver function and coagulation function in patients with liver failure.However,1/2PE+DPMAS shows a more significant and superior effect in improving the short-term efficacy and survival rate of patients with early liver failure.
作者
宁小元
陈勇
茹彦海
徐家云
NING Xiaoyuan;CHEN Yong;RU Yanhai;XU Jiayun(Department of Nephrology,College of Clinical Medicine'Henan University of Science and Technology/the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)
出处
《临床医学工程》
2025年第12期1375-1379,共5页
Clinical Medicine & Engineering
基金
北京惠康仁爱公益基金会课题研究项目(项目编号:BHCF20230720)。
关键词
人工肝
组合模式
肝衰竭
治疗效果
安全性
Artificial liver
Combined mode
Liver failure
Therapeutic effect
Safety
