Objective: To investigate how plasma exchange (PE) and double plasma molecular adsorption combined with half-volume plasma exchange (DPMAS + half-volume PE) affect the curative effect and short-term survival rate in liver failure. Methods: Data from 181 cases of liver failure caused by different etiologies from January 1, 2017 to September 31, 2020, were selected. Patients were divided into a PE treatment alone group and a DPMAS + half-dose PE treatment group. The laboratory indicators with different models of artificial liver before and after treatment and the survival rates of 7, 14, 28, and 90 days after discharge were observed in the two groups. Measurement data were analyzed by t-tests and rank sum tests. Categorical data were analyzed by χ (2) test. Results: Non-biological artificial liver therapy with different models improved the liver and coagulation function in the two groups of patients with liver failure (P < 0.05 in PTA% intra-group). The coagulation function was significantly improved in the PE treatment alone group compared with that in the DPMAS + half-dose PE group [PT after treatment: (20.15 ± 0.88) s in the PE treatment alone group, (23.43 ± 1.02) s, t = -2.44, P = 0.016 in the DPMAS+half-dose PE group; PTA: 44.72% ± 1.75% in the PE treatment alone group, 35.62% ± 2.25%, t = 3.215 P = 0.002 in the DPMAS + half-dose PE group]. Bilirubin levels were significantly decreased in the DPMAS+half-dose PE group compared to the PE treatment alone group [total bilirubin after treatment: (255.30 ± 15.64) μmol/L in the PE treatment alone group, (205.46 ± 9.03) μmol/L, t = 2.74, P = 0.07 in the DPMAS + half-dose PE group; direct bilirubin after treatment: (114.74 ± 7.11) μmol/L in the PE treatment alone group, (55.33 ± 3.18) μmol/L, t = 7.54, P < 0.001) in the DPMAS + half-dose PE group]. However, there was no significant effect on leukocytes and neutrophils after treatment with different models of artificial liver (P > 0.05) in the two groups, and platelets decreased after treatment, with no statistically significant difference between the groups (t = -0.15, P = 0.882). The inflammatory indexes of the two groups improved after treatment with different models of artificial liver (P < 0.05], and the 28 and 90 d survival rates were higher in the DPMAS+half-dose PE group than those of the PE treatment alone group (28 d: 60.3% vs. 75.0%, χ (2) = 4.315, P = 0.038; 90 d: 56.2% vs. 72.5%. χ (2) = 10.355 P < 0.001). DPMAS + half-dose PE group plasma saving was 1385 ml compared with PE treatment alone group (Z = -7.608, P < 0.05). Conclusion: Both DPMAS+half-dose PE and PE treatment alone have a certain curative effect on patients with liver failure. In DPMAS+half-dose PE, the 28-day survival rate is superior to PE treatment alone, and it saves plasma consumption and minimizes blood use in clinic.
目的： 探讨血浆置换（PE）与双重血浆分子吸附联合半量血浆置换（DPMAS+半量PE）对肝衰竭治疗的疗效及短期生存率的影响。 方法： 选取2017年1月1日-2020年9月31日的181例不同病因导致的肝衰竭患者资料，患者分为单纯PE治疗组与DPMAS +半量PE治疗组。观察2组不同模式人工肝治疗前后各项实验室指标、出院后7 d、14 d、28 d、90 d的生存率。对计量资料数据进行t检验、秩和检验分析，计数资料数据使用χ(2)检验分析。 结果： 两组不同模式的非生物型人工肝治疗肝衰竭都可以改善患者肝功能及凝血功能[凝血酶原活动度（PTA）组内P < 0.05]，单纯PE组对于凝血功能较DPMAS +半量PE组改善明显[治疗后凝血酶原时间（PT）：单纯PE组为（20.15±0.88）s，DPMAS +半量PE组为（23.43±1.02）s，t = -2.44，P = 0.016；PTA：单纯PE组为44.72%±1.75%，DPMAS +半量PE组为35.62%±2.25%，t = 3.215，P = 0.002]；DPMAS +半量PE组较单纯PE组胆红素水平下降明显[治疗后总胆红素：单纯PE组为（255.30±15.64）μmol/L、DPMAS +半量PE组为（205.46±9.03）μmol/L，t = 2.74，P = 0.07；治疗后间接胆红素：单纯PE组为（114.74±7.11）μmol/L、DPMAS +半量PE组为（55.33±3.18）μmol/L，t = 7.54，P < 0.001]；而两组不同模式人工肝治疗后对白细胞及中性粒细胞均无明显影响（P>0.05），治疗后血小板均有下降，但组间差异无统计学意义（t = -0.15，P = 0.882）。两组不同模式人工肝治疗后炎症指标均好转（P<0.05）；DPMAS +半量PE组28 d、90 d生存率高于单纯PE组（28d：60.3%与75.0%，χ(2) = 4.315，P = 0.038；90 d：56.2%与72.5%。χ(2) = 10.355，P < 0.001）；DPMAS +半量PE组比单纯PE组节约血浆量为1 385 ml（Z = -7.608，P < 0.05）。 结论： DPMAS +半量PE与单纯PE对肝衰竭患者均有一定的疗效，DPMAS +半量PE 28 d生存率优于单纯PE，且节约血浆用量，减轻临床用血压力。.
Keywords: Curative effect; Double bilirubin adsorption combined with half volume plasma exchange; Liver failure; Plasma exchange.