Objective: To compare the effectiveness and safety profile of centrifugal and membrane plasma separation model in artificial liver therapy with a dual plasma molecular adsorption system (DPMAS). Method: A retrospective study was conducted. Data of inpatients with liver failure who were treated with DPMAS therapy in the Liver Disease Center of Nanfang Hospital, Southern Medical University, from October 2022 to June 2024 were included. Clinical data such as demographic characteristics, etiology, DPMAS treatment-related indicators (including plasma separation method, vascular access, frequency of treatment, treatment duration, type of anticoagulant drugs, and membrane rupture condition), and laboratory test indicators before and after DPMAS treatment were collected. Categorical variables were compared by the χ² test. Continuous variables were compared using a t-test or a non-parametric test between groups. Result: Data of 232 cases with liver failure who received artificial liver therapy with DPMAS were included. A total of 473 times DPMAS treatment was given. The average age was 50 years old, and males accounted for 82.3%. Centrifugal plasma separation was the initial DPMAS treatment in 176 (75.9%) cases, while membrane plasma separation was used in 56 cases (24.1%). The most common vascular access for DPMAS treatment was the internal jugular vein. The most commonly used anticoagulant was unfractionated heparin. The treatment duration of DPMAS was significantly higher with centrifugal separation than that with membrane separation (P<0.001). Hemoglobin levels (mean before and after treatment in the centrifugal: 112.8 g/L vs. 106.3 g/L, P<0.001; mean before and after treatment in the membrane group: 108.4 g/L vs. 103.3 g/L, P<0.001), red blood cell count (mean before and after treatment in the centrifugal group: 3.7×109/L vs. 3.5×109/L, P<0.001; mean before and after treatment in the membrane group: 3.5×109/L vs. 3.3×109/L, P<0.001) and platelet count (mean before and after treatment in the centrifugal group: 134.5×109/L vs. 119.6×109/L, P<0.001; mean before and after treatment in the membrane group: 120.7 ×109/L vs. 97.3 ×109/L, P<0.001) were slightly decreased following initial DPMAS treatment in both groups. The decrease in platelets was significantly lower in centrifugal separation than that in membrane separation (median: 10.4% vs. 17.0%; P=0.003). There was no statistically significant difference observed in the proportion of puncture site bleeding in terms of plasma separation-related adverse events between the two groups, but plasma separator membrane rupture occurred two times in the DPMAS treatment. Conclusion: Centrifugal and membrane separation, both with DPMAS therapy, can cause a slight decrease in hemoglobin, red blood cell count, and platelets in patients with liver failure. Membrane separation causes a larger drop in platelets than centrifugal plasma separation. The operational convenience of medical personnel, the risk of membrane rupture, the coagulation markers, the patient's vascular condition, and other factors should be comprehensively considered when choosing the plasma separation model.
目的： 比较离心式和膜式血浆分离模式在双重血浆分子吸附系统（DPMAS）模式人工肝治疗中的有效性和安全性。 方法： 该研究为回顾性研究。纳入南方医科大学南方医院肝病中心2022年10月至2024年6月住院接受DPMAS治疗的肝衰竭患者资料。收集人口统计学特征、病因、DPMAS治疗相关指标（包括血浆分离方式、血管通路、治疗次数、治疗时长、抗凝药物种类、破膜情况）、DPMAS治疗前后的实验室检验指标等临床资料。分类变量用χ2检验进行比较；连续变量的组间比较用t检验或非参数检验。 结果： 纳入232例接受DPMAS人工肝治疗的肝衰竭患者资料，共接受473次DPMAS治疗。平均年龄50岁，男性占82.3%，176例（75.9%）患者首次DPMAS治疗为离心式血浆分离，56例（24.1%）为膜式血浆分离。颈内静脉为DPMAS治疗最常见的血管通路。普通肝素是最常使用的抗凝药物。离心式分离的DPMAS治疗时长显著高于膜式分离（P值<0.001）。首次DPMAS治疗后，两种分离模式的血红蛋白（离心式组治疗前后均值：112.8 g/L比106.3 g/L，P<0.001；膜式组治疗前后均值：108.4 g/L比103.3 g/L，P<0.001）、红细胞计数（离心式组治疗前后均值：3.7×109/L比3.5×109/L，P<0.001；膜式组治疗前后均值：3.5×109/L比3.3×109/L，P<0.001）及血小板（离心式组治疗前后均值：134.5×109/L比119.6×109/L，P<0.001；膜式治疗前后均值：120.7×109/L比97.3×109/L，P<0.001）治疗后均轻微下降。离心式分离的血小板下降幅度显著低于膜式分离（中位数：10.4%比17.0%；P=0.003）。血浆分离相关不良事件方面，两组穿刺口出血比例差异无统计学意义，2次DPMAS治疗观察到血浆分离器破膜。 结论： 离心式和膜式分离的DPMAS治疗均会引起肝衰竭患者血红蛋白、红细胞计数和血小板的轻微降低。相比于离心式血浆分离，膜式分离的血小板下降幅度更大。血浆分离模式的选择应综合考虑：患者血管条件、凝血指标、破膜风险、医护人员的操作便利性等因素。.