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摘要：
目的 观察双重血浆分子吸附系统（double plasma molecule adsorb system, DPMAS）治疗慢加急性肝衰竭（acute‑on‑chronic liver failure, ACLF）的临床疗效和安全性。 方法 回顾性分析徐州医科大学附属医院2019年1月至2021年8月接受人工肝支持系统（以下简称人工肝）治疗的ACLF患者的临床资料。根据人工肝治疗方法分为DPMAS组（69例）和血浆置换（plasma exchange, PE）组（75例），使用倾向性评分1∶1匹配两组患者，实际配对每组各64例患者。在内科综合治疗的基础上，DPMAS组患者行DPMAS治疗，PE组患者行PE治疗。收集两组患者一般资料、实验室检查资料［血常规、肝功能、凝血功能及C反应蛋白（C‑reactive protein, CRP）］及不良反应，计算人工肝治疗后的总胆红素（total bilirubin, TBIL）清除率、凝血酶原活动度（prothrombin time activity, PTA）升高率；比较两组患者的临床疗效（治疗有效率）和末次人工肝治疗结束后28 d生存率。 结果 人工肝治疗后DPMAS组AST、ALT、白蛋白（albumin, ALB）、TBIL、直接胆红素（direct bilirubin, DBIL）及外周血RBC、Hb、血小板（platelet, PLT）、WBC、中性粒细胞（neutrophil, NE）、CRP浓度均低于PE组（P<0.05），PTA、TBIL清除率及PTA升高率高于PE组（P<0.05）。与治疗前比较：治疗后两组AST、ALT、TBIL、DBIL、国际标准化比值（international normalized ratio, INR）及外周血RBC、Hb、PLT、CRP浓度降低（P<0.05），PTA升高（P<0.05）；DPMAS组外周血ALB、WBC、NE浓度降低。DPMAS组不良反应发生率低于PE组（P<0.05），治疗有效率和末次人工肝治疗结束后28 d生存率高于PE组（P<0.05）。其他指标两组差异无统计学意义（P>0.05） 结论 DPMAS治疗ACLF患者疗效显著，可以有效清除TBIL，升高PTA，减轻炎症反应，改善末次人工肝治疗结束后28 d生存率，治疗效果及安全性均优于PE治疗。
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Abstract: Objective To observe the clinical effectiveness and safety of the double plasma molecule adsorption system (DPMAS) in the treatment of acute‑on‑chronic liver failure (ACLF). Methods A retrospective study was performed using clinical data from ACLF patients who received artificial liver support system in the Affiliated Hospital of Xuzhou Medical University from January 2019 to August 2021. According to the method of artificial liver support system, they were divided into two groups: a DPMAS group (n=69) and a plasma exchange (PE) group (n=75). Propensity score matching was used with a 1∶1 ratio to assign the two groups, and 64 patients in each group were actually paired. On the basis of standardized medical treatment, patients in the DPMAS group received DPMAS, while those in the PE group underwent PE therapy. Their general information, laboratory data [blood routine, liver function, coagulation function and C‑reactive protein (CRP)], and adverse reactions were collected. The total bilirubin (TBIL) clearance rate and prothrombin time activity (PTA) elevation rate after treatment with artificial liver support system were calculated. The two groups were compared for clinical effectiveness (effective rate) and 28‑day survival rate after the end of the last artificial liver support system treatment. Results After artificial liver support system treatment, the DPMAS group showed decreases in aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), TBIL, direct bilirubin (DBIL) and red blood cell (RBC), hemoglobin (Hb), platelet (PLT), white blood cell (WBC), neutrophil (NE), and CRP in peripheral blood, compared with the PE group (P<0.05). The DPMAS group also presented higher PTA, TBIL clearance rate, and PTA elevation rate than the PE group (P<0.05). Compared with those before treatment, both groups showed decreases in AST, ALT, TBIL, DBIL, international normalized ratio (INR), RBC, Hb, PLT and CRP after treatment (P<0.05), increases in PTA, while reduced ALB, WBC, and NE were found in the DPMAS group. Compared with the PE group, the DPMAS group presented a decreased incidence of adverse reactions (P<0.05), with increases in the effective rate and the 28‑day survival rate after the end of the last artificial liver support system treatment (P<0.05). No statistical differences were found in other indexes between the two groups (P>0.05). Conclusions DPMAS is effective and safe in the treatment of ACLF, which can effectively decrease TBIL, increase PTA, reduce inflammation response, and improve 28‑day survival rate after the end of the last artificial liver support system treatment, with better effectiveness and safety than EP therapy.
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