DPMAS联合半量PE治疗慢加急性肝衰竭的临床效果及短期预后分析

王莹莹; 闫冬; 王馨; 任佩佩; 张璨; 薛鹏涵; 高飞; 曾艳丽

doi:10.16766/j.cnki.issn.1674-4152.004076

DPMAS联合半量PE治疗慢加急性肝衰竭的临床效果及短期预后分析

doi: 10.16766/j.cnki.issn.1674-4152.004076

王莹莹¹,
闫冬¹,
王馨²,
任佩佩³,
张璨³,
薛鹏涵⁴,
高飞^{1, 3},
曾艳丽^{1, 2, 3, 4, ,}

1.
郑州大学人民医院感染科，河南郑州 450003
2.
河南大学人民医院感染科，河南郑州 450003
3.
河南省人民医院感染科，河南郑州 450003
4.
新乡医学院河南省人民医院感染科，河南郑州 450003

基金项目:

北京肝胆相照公益基金会2023年度人工肝专项基金 iGandanF-1082023-RGG003

河南省医学科技攻关计划项目 LHGJ20220078

中华护理学会科研课题 ZHKYQ202220

详细信息

通讯作者:
曾艳丽，E-mail：zyldd1212@126.com

中图分类号: R575.3 R459.5
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- 文章访问数: 6
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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-05
- 网络出版日期: 2025-10-25

Clinical Efficacy and Short-Term Prognosis Analysis of DPMAS Combined with Half-Volume PE in the Treatment of Acute-on-Chronic Liver Failure

WANG Yingying¹,
YAN Dong¹,
WANG Xin²,
REN Peipei³,
ZHANG Can³,
XUE Penghan⁴,
GAO Fei^{1, 3},
ZENG Yanli^{1, 2, 3, 4
, ,}

1.
Department of Infectious Diseases, People' s Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China

摘要

摘要: 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联合半量PE)对慢加急性肝衰竭的临床疗效指标改善情况及短期生存率的影响。方法选取2021年1月—2023年7月河南省人民医院住院的132例慢加急性肝衰竭患者，根据治疗方式分为PE治疗组(83例)和DPMAS联合半量PE治疗组(49例)。观察2组患者在不同模式人工肝治疗前后实验室指标及出院后7 d、28 d、90 d死亡率。结果治疗后PE治疗组HB较DPMAS联合半量PE治疗组明显下降，差异有统计学意义(P＜0.05)。2种治疗模式均可改善患者的肝功能(P＜0.05)，PE治疗组在改善凝血功能方面优于DPMAS联合半量PE治疗组(P＜0.05)。2组患者胆红素水平、不良反应发生率比较差异均无统计学意义(P＞0.05)，但DPMAS联合半量PE治疗组患者的90 d累计死亡率显著低于PE治疗组[10例(20.4%) vs. 31例(37.3%)], 差异有统计学意义(P＜0.001)。结论 DPMAS联合半量PE治疗可以有效改善慢加急性肝衰竭患者的肝功能，并显著提高慢加急性肝衰竭患者的生存率；此外，还可缓解血浆资源短缺问题，明显改善肝衰竭患者的预后，为患者过渡到肝移植提供更多的时间。
- 慢加急性肝衰竭 /
- 人工肝支持系统 /
- 血浆置换 /
- 双重血浆分子吸附联合半量血浆置换
Abstract: Objective To explore the effects of plasma exchange (PE) and dual plasma molecular adsorption combined with half-volume plasma exchange (DPMAS combined with half-volume PE) on the improvement of clinical efficacy indices and short-term survival of the treatment of slow plus acute liver failure. Methods A total of 132 patients with acute-on-chronic liver failure, who were hospitalized at Henan Provincial People' s Hospital from January 2021 to July 2023, were selected. According to the treatment modality, patients were divided into the PE treatment group (83 cases) and the DPMAS combined with half-dose PE treatment group (49 cases). Laboratory parameters and mortality rates at 7 days, 28 days, and 90 days post-discharge were monitored in both groups before and after the different modes of artificial liver treatment. Results After treatment, the HB variation in the PE-treatment group demonstrated a significantly greater magnitude of change compared to the DPMAS combined with half-volume PE treatment group, with this differences attaining statistical significance (P < 0.05). Both treatment modalities improved liver function (P < 0.05), with the PE treatment group showing superior results in coagulation function compared to the DPMAS combined with half-dose PE group (P < 0.05). No statistically significant differences were observed in the comparison of bilirubin level changes and adverse reaction incidence rates between the two groups (P>0.05), but the cumulative 90-day mortality rate was significantly lower in the DPMAS combined with half-dose PE group (PE group: 31 cases, 37.3%; DPMAS combined with half-dose PE group: 10 cases, 20.4%), with statistical significance (P < 0.001). Conclusion The DPMAS combined with half-dose PE treatment is effective in improving liver function and significantly enhancing survival rates in patients with acute-on-chronic liver failure. Additionally, it addresses the issue of plasma resource shortages and markedly improves the prognosis for liver failure patients, providing more time for transitioning to liver transplantation.
- Acute-on-chronic liver failure /
- Artificial liver support system /
- Plasma exchange /
- Double plasma molecular adsorption combined with half-volume plasma exchange

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表 1 2组慢加急性肝衰竭患者治疗前后各项指标比较

Table 1. Comparison of various indicators before and after treatment between the two groups of patients with acute-on-chronic liver failure

组别	例数	时间	RBC(×10¹²/L)	WBC(×10⁹/L)	PLT(×10⁹/L)	HB(g/L)	ALT(U/L)
PE治疗组	83	治疗前	3.41±0.82	8.39(5.61, 11.84)	110.0(59.5, 167.5)	110.05±21.20	78.70(40.40, 161.55)
		治疗后	3.20±0.82^a	8.03(5.05, 10.87)^a	98.0(53.0, 149.5)^a	103.20±21.33^a	42.30(26.35, 75.83)^a
DPMAS联合半量PE治疗组	49	治疗前	3.52±0.69	7.58(5.10, 10.50)	124.0(69.0, 183.0)	114.70±17.90	65.65(46.00, 112.48)
		治疗后	3.46±0.69^b	8.90(6.01, 12.98)^ab	124.0(69.0, 174.0)^a	113.42±18.18^b	44.35(31.68, 68.88)^ab

组别	例数	时间	AST(U/L)	TP(g/L)	ALB(g/L)	PAB(g/L)	TBIL(μmol/L)
PE治疗组	83	治疗前	108.2(64.2, 200.4)	53.8(49.6, 57.9)	31.40(29.03, 34.10)	78(53, 116)	252.25(169.98, 356.00)
		治疗后	56.9(38.7, 91.9)^a	51.1(48.0, 54.4)^a	32.00(30.00, 33.68)^a	150(137, 170)^a	138.90(89.10, 198.20)^a
DPMAS联合半量PE治疗组	49	治疗前	79.4(53.2, 152.2)	52.4(49.1, 55.9)	30.70(28.23, 33.25)	78.17±38.25	236.10(159.93, 359.40)
		治疗后	53.8(39.4, 102.3)^ab	46.8(44.9, 50.9)^ab	29.35(27.53, 30.88)^ab	94.59±23.76^ab	138.55(92.55, 207.03)^a

组别	例数	时间	DBIL(μmol/L)	IBIL(μmol/L)	ALP(U/L)	GGT(U/L)	LDH(U/L)
PE治疗组	83	治疗前	184.20(126.00, 256.90)	64.1(42.0, 93.3)	128.7(98.2, 174.2)	90.70(54.75, 186.40)	259(196, 321)
		治疗后	101.40(62.50, 140.30)^a	35.7(23.7, 50.3)^a	87.4(72.6, 109.7)^a	51.40(35.65, 95.43)^a	208(175, 259)^a
DPMAS联合半量PE治疗组	49	治疗前	176.25(113.18, 261.83)	56.3(38.6, 91.9)	116.8(99.2, 166.0)	85.35(59.25, 192.30)	233(183, 330)
		治疗后	99.90(67.28, 153.18)^a	32.9(22.5, 53.4)^a	91.6(74.8, 128.0)^ab	60.40(40.70, 124.35)^a	204(163, 250)^a

组别	例数	时间	GLU(mmol/L)	Scr(μmol/L)	Na⁺(mmol/L)	K⁺(mmol/L)	PT(s)
PE治疗组	83	治疗前	5.71(4.51, 7.47)	57.00(46.01, 79.01)	137(134, 140)	3.99(3.54, 4.39)	27.60(24.70, 30.90)
		治疗后	7.90(6.30, 10.00)^a	53.21(42.01, 75.04)^a	137(134, 139)^a	3.81(3.35, 4.22)^a	15.00(13.90, 16.30)^a
DPMAS联合半量PE治疗组	49	治疗前	6.50(4.38, 7.85)	58.00(45.00, 73.00)	137(134, 138)	4.13(3.60, 4.81)	27.00(23.95, 32.00)
		治疗后	7.70(5.55, 10.30)^a	52.01(42.51, 67.00)^a	135(132, 137)^a	4.08(3.66, 4.46)	27.20(25.20, 31.15)^b

组别	例数	时间	PTA(%)	INR	TT(s)	FIB/FG(g/L)	D-D(μg/mL)
PE治疗组	83	治疗前	34.25(22.75, 52.03)	1.60(1.34, 1.81)	21.10(19.60, 23.20)	1.32(0.97, 1.83)	2.26(0.94, 4.15)
		治疗后	69.85(60.50, 78.40)^a	1.26(1.17, 1.40)^a	22.75(20.80, 26.73)^a	1.17(0.96, 1.50)^a	1.57(0.81, 3.23)^a
DPMAS联合半量PE治疗组	49	治疗前	36.35(27.50, 39.08)	1.45(1.16, 1.78)	21.25(19.23, 24.60)	1.32(0.84, 2.14)	1.69(0.73, 4.32)
		治疗后	35.81(25.85, 39.08)^b	1.45(1.24, 1.77)^b	23.45(20.60, 31.28)^a	1.01(0.74, 1.49)^a	1.50(0.74, 3.31)^a
注：与治疗前比较，^aP＜0.05；与PE治疗组比较，^bP < 0.05。正态分布的计量资料以x ±s表示，非正态分布的计量资料以M(P₂₅, P₇₅)表示。

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表 2 2组慢加急性肝衰竭患者出院后7 d、28 d、90 d死亡率比较[例(%)]

Table 2. Comparison of mortality at 7, 28, and 90 days after discharge between the two groups of patients with acute-on-chronic liver failure [cases (%)]

组别	例数	7 d	28 d	90 d
PE治疗组	83	16(19.3)	19(22.9)	31(37.3)
DPMAS联合半量PE治疗组	49	7(14.3)	7(14.3)	10(20.4)
注：Waldχ_治疗方式²=-0.484，P_治疗方式＜0.001；Waldχ_时间²=0.285，P_时间＜0.001。

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参考文献(17)

[1]	康玮玮, 田辉, 冯丽丽, 等. 慢加急性肝衰竭患者长期生存状况变化及临床特点分析[J]. 肝脏, 2022, 27(5): 516-520. KANG W W, TIAN H, FENG L L, et al. Analysis on the long-term survival status and clinical characteristics of patients with acute-on-chronic liver failure[J]. Chinese Hepatology, 2022, 27(5): 516-520.
[2]	罗可, 刘波颖. 非生物型人工肝三种不同治疗模式在肝衰竭治疗中的研究进展[J]. 中国医药科学, 2024, 14(10): 30-33. LUO K, LIU B Y. Research progress of three different treatment modes of non-bioartificial liver in the treatment of liver failure[J]. China Medicine And Pharmacy, 2024, 14(10): 30-33.
[3]	LI Z W, TU S, YU X, et al. Hepatic and extrahepatic metabolic modulation in hbv-related decompensated cirrhosis and acute-on-chronic liver failure[J]. Virulence, 2024, 15(1): 2404953. DOI: 10.1080/21505594.2024.2404953.
[4]	李瑾, 李静, 柴梅, 等. DPMAS联合LPE与PE治疗乙型肝炎病毒相关早期肝衰竭的疗效对比和预后影响因素分析[J]. 临床和实验医学杂志, 2023, 22(3): 257-262. LI J, LI J, CHAI M, et al. Comparison and analysis of prognostic factors of DPMAS combination with LPE and PE in early HBV-associated liver failure[J]. Journal of Clinical and Experimental Medicine, 2023, 22(3): 257-262.
[5]	赵英妹, 聂红明, 张珏, 等. 肝硬化患者凝血五项的测定及其临床意义[J]. 诊断学理论与实践, 2021, 20(5): 480-483. ZHAO Y M, NIE H M, ZHANG J, et al. Detection of five coagulation indices in patients with cirrhosis and its clinical significance[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(5): 480-483.
[6]	李海. 慢加急肝衰竭的诊断标准及管理[J]. 诊断学理论与实践, 2021, 20(5): 434-438. LI H. Diagnostic criteria and management of acute-on-chronic liver failure[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(5): 434-438.
[7]	李建州, 李晓青, 杨英, 等. 适用于生物人工肝的3种不同肝细胞的增殖能力及代谢功能的比较研究[J]. 医学研究杂志, 2021, 50(8): 51-55. LI J Z, LI X Q, YANG Y, et al. Comparative study on the proliferation and metabolic functions of three different liver cell lines suitable for bioartificial liver[J]. Journal of Medical Research, 2021, 50(8): 51-55.
[8]	黄玥, 彭虹, 罗新华. 组合型人工肝的研究进展[J]. 临床肝胆病杂志, 2024, 40(2): 233-238. HUANG Y, PENG H, LUO X H. Research advances in combined artificial liver[J]. Journal of Clinical Hepatology, 2024, 40(2): 233-238.
[9]	中华医学会肝病学分会重型肝病与人工肝学组. 人工肝血液净化技术临床应用专家共识(2022年版)[J]. 实用肝脏病杂志, 2022, 25(3): 457-468. Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Expert consensus on clinical application of artificial liver and blood purification (2022 edition)[J]. Journal Of Practical Hepatology, 2022, 25(3): 457-468.
[10]	王璐, 许文雄, 彭亮. 组合型非生物型人工肝治疗成人慢加急性肝衰竭的研究进展[J]. 临床肝胆病杂志, 2022, 38(7): 1662-1666. WANG L, XU W X, PENG L. Research advances in combined non-bioartificial liver in treatment of acute-on-chronic liver failure in adults[J]. Journal of Clinical Hepatology, 2022, 38(7): 1662-1666.
[11]	秦维, 祝素平, 郑艳丽, 等. PE结合DPMAS对肝硬化并发慢加急性肝衰竭患者生存状况的影响[J]. 传染病信息, 2021, 34(2): 140-143, 147. QIN W, ZHU S P, ZHENG Y L, et al. Effect of PE combined with DPMAS on survival of patients with liver cirrhosis complicated with chronic and acute liver failure[J]. Infectious Disease Information, 2021, 34(2): 140-143, 147.
[12]	邹波, 朱龙川, 甘达凯, 等. 低置换量血浆置换术联合双重血浆分子吸附术治疗慢加急性肝衰竭患者短期预后的结果[J]. 实用医学杂志, 2024, 40(3): 348-352, 359. ZOU B, ZHU L C, GAN D K, et al. Effects of LPE combined with DPMAS on liver function and inflammatory cytokines in patients with acute?chronic liver failure[J]. The Journal of Practical Medicine, 2024, 40(3): 348-352, 359.
[13]	文苑, 祝娟娟. 双重血浆分子吸附系统序贯血浆置换联合连续性肾脏替代疗法治疗慢加急性肝衰竭合并急性肾损伤的效果分析[J]. 临床肝胆病杂志, 2024, 40(3): 556-561. WEN Y, ZHU J J. Clinical efficacy of double plasma molecular absorption system and sequential plasma exchange combined with continuous renal replacement therapy in treatment of acute-on-chronic liver failure with acute kidney injury[J]. Journal of Clinical Hepatology, 2024, 40(3): 556-561.
[14]	李新婷, 姚瑶, 郑嵘炅, 等. 血浆置换与双重血浆分子吸附联合半量血浆置换对肝衰竭治疗的疗效及短期生存率分析[J]. 中华肝脏病杂志, 2023, 31(7): 736-741. LI X T, YAO Y, ZHENG R Z, et al. Analysis of curative effect and short-term survival rate of plasma exchange and double plasma molecular adsorption combined with half-volume plasma exchange in the treatment of liver failure[J]. Chinese Journal of Hepatology, 2023, 31(7): 736-741.
[15]	陈茹茹, 罗厚江, 杨军, 等. 低分子量肝素联合新鲜冰冻血浆在危重新生儿凝血功能异常中的应用[J]. 中华全科医学, 2021, 19(4): 607-610. doi: 10.16766/j.cnki.issn.1674-4152.001873 CHEN R R, LUO H J, YANG J, et al. Application of low molecular weight heparin combined with fresh frozen plasma in the treatment of coagulation abnormalities in critically ill neonates[J]. Chinese Journal of General Practice, 2021, 19(4): 607-610. doi: 10.16766/j.cnki.issn.1674-4152.001873
[16]	代梅, 申友书, 赵菲, 等. 血浆置换联合双重血浆吸附模式人工肝治疗对纤维蛋白原的影响[J]. 肝脏, 2023, 28(5): 523-526. DAI M, SHEN S Y, ZHAO F, et al. Effect of plasma replacement combined with dual plasma adsorption mode artificial liver therapy on fibrinogenJ]. Chinese Hepatology, 2023, 28(5): 523-526.
[17]	张露侃, 蒋素文, 胡爱荣. 组合型非生物人工肝支持系统治疗肝衰竭的研究进展[J]. 现代实用医学, 2023, 35(6): 834-837. ZHANG L K, JIANG S W, HU A R. Advances in the treatment of liver failure with a combined abiotic artificial liver support system[J]. Modern Practical Medicine, 2023, 35(6): 834-837.