双重血浆吸附、胆红素吸附及血浆置换治疗肝衰竭的疗效比较

Comparison of clinical effects of double plasma molecular adsorption system, plasma bilirubin adsorption and plasma exchange in liver failure

摘要:

目的  观察双重血浆吸附（DPMAS）、胆红素吸附（PBA）及血浆置换（PE）治疗肝衰竭的临床疗效，寻找能替代血浆置换的新模式。方法  将南华大学附属南华医院40例行人工肝治疗的肝衰竭患者，分为DPMAS组、PBA组和PE组，观察生化指标、不良反应和临床症状，并行治疗前后对比和3组间多重对比。 结果  DPMAS和PE均能显著降低总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）及C反应蛋白（CRP），升高凝血酶原时间活动度（PTA）。PBA仅降低TBI和DBIL，对其他疗效不显著。PE组降低TBIL、ALT和升高PTA的效果最佳。DPMAS组与之相近，且CRP下降率高于PE组。3组治疗均能不同程度改善临床症状，PE组的不良反应明显，DPMAS组好转率高于其他两组。结论  双重血浆吸附术的疗效明显优于胆红素吸附术，与血浆置换相当，又能显著清除炎症因子，克服血浆缺乏和过敏等缺点，仅需增加设备和费用的支持，可作为替代血浆置换的新模式。

关键词:

肝衰竭;人工肝;血浆置换;胆红素吸附;双重血浆吸附

Abstract:

Objective To observe the clinical effects of double plasma molecular adsorption system (DPMAS), plasma bilirubin adsorption (PBA) and Plasma exchange (PE) in liver failure, and to explore a new treatment model to replace plasma exchange. Methods A total of 40 patients with liver failure and received treatment of artificial liver in our hospital was divided into DPMAS, PBA and PE group. The biochemical indexes, adverse reactions and clinical symptoms in the three groups were observed, and multiple comparisons before and after treatment and among those three groups were conducted. Results The DPMAS and the PE group presented significant effects on total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), C reactive protein (CRP) and prothrombin activity (PTA) while the PBA group was observed to be effective on TBIL and DBIL only. The multiple comparisons among the three groups indicated that the PE group had the optimal treatment effects, followed by the DPMAS group. All three groups improved the clinical symptoms, but the PE group presented significant adverse reactions. However, the recovery rate of the DPMAS group was higher than the other two groups. Conclusions The treatment effects of DPMAS are equivalent to those of PE and have overcome the disadvantages of plasma deficiency and allergy. Only increasing the cost of equipment and consumables, DPMAS is applicable as the new model to replace plasma exchange.

Key words:

liver failure; artificial liver; plasma exchange; plasma bilirubin adsorption; double plasma molecular adsorption system