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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

文苑 祝娟娟

引用本文:
Citation:

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

DOI: 10.12449/JCH240319
基金项目: 

北京肝胆相照公益基金会人工肝专项基金课题 (RGGJJ-2021-001);

贵州省科技厅基础研究计划项目(黔科合基础-ZK〔2022〕一般452) 

伦理学声明:本研究方案于2023年4月6日经由贵州医科大学附属医院医学科学伦理委员会审批,批号:2023伦审第351号。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:文苑负责数据收集、处理及论文撰写;祝娟娟负责拟定写作思路、文章修订。
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    通信作者:

    祝娟娟, 184184239@qq.com (ORCID: 0000-0003-0692-9200)

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

Research funding: 

Beijing Liver and Gall Blessing Foundation Artificial Liver Special Fund Project (RGGJJ-2021-001);

Fundamental Research Project of Guizhou Provincial Science and Technology Department(Qiankehe Foundation-ZK[2022] General 452) 

More Information
    Corresponding author: ZHU Juanjuan, 184184239@qq.com (ORCID: 0000-0003-0692-9200)
  • 摘要:   目的  观察双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)联合连续性肾脏替代疗法(CRRT)治疗慢加急性肝衰竭(ACLF)合并急性肾损伤(AKI)患者的临床效果。  方法  回顾性纳入2019年1月—2022年12月于贵州医科大学附属医院住院治疗的ACLF合并AKI的90例患者临床资料,依据不同的血液净化方式,分为DPMAS序贯PE联合CRRT组(观察组,n=31),DPMAS序贯PE组(对照组,n=59)。收集所有患者入院一般资料、血液净化治疗前后实验室指标,包括肝肾功能、凝血功能、炎症指标等,计算eGFR、MELD-Na评分。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料组内前后比较采用Wilcoxon符号秩和检验,两组间比较采用Mann-Whitney U检验。计数资料两组比较采用χ2检验或Fisher精确检验。  结果  观察组治疗有效率为48.4%(15/31),高于对照组治疗的有效率27.1%(16/59)(χ2=4.071,P=0.044)。两组血液净化方式均可有效改善TBil、ALT、AST、PTA、Scr、PCT、CRP、eGFR及MELD-Na评分(P值均<0.05);两组治疗后PLT及Hb均显著降低(P值均<0.05);而BUN、Alb、INR治疗前后差异均无统计学意义(P值均>0.05)。对照组与观察组的AST、Scr、PCT、eGFR、MELD-Na评分、Hb、PLT治疗前后差值比较,差异均有统计学意义(P值均<0.05)。  结论  DPMAS序贯PE联合CRRT模式可有效清除炎症介质,改善肾功能,稳定机体内环境,获得较好的临床疗效。

     

  • 表  1  两组治疗前后生化指标比较

    Table  1.   Comparison of biochemical indicators between the two groups before and after treatment

    指标 观察组(n=31) 对照组(n=59)
    治疗前 治疗后 P 治疗前 治疗后 P
    TBil(µmol/L) 329.5(165.1~457.6) 151.1(75.4~233.0) <0.001 312.7(218.4~457.8) 217.6(76.8~337.5) <0.001
    ALT(U/L) 160.0(83.0~355.2) 42.2(28.7~73.8) 0.001 92.1(42.8~345.5) 43.1(24.7~89.8) <0.001
    AST(U/L) 321.2(217.7~512.0) 78.0(48.1~335.4) <0.001 166.7(113.8~430.4) 83.7(49.8~141.2) <0.001
    Alb(g/L) 27.6(25.5~31.1) 27.9(25.6~33.1) 0.829 29.8(26.1~32.5) 27.8(24.3~32.4) 0.098
    PTA(%) 34.3(28.2~41.0) 41.7(29.3~53.2) 0.009 36.0(29.7~45.6) 38.7(27.3~56.6) 0.008
    INR 2.3(1.7~2.7) 1.8(1.6~2.6) 0.189 2.2(1.8~2.6) 2.0(1.5~2.8) 0.069
    BUN(mmol/L) 16.4(9.8~25.5) 9.2(6.6~19.6) 0.060 14.0(11.0~16.0) 12.2(7.1~17.3) 0.357
    Scr(µmol/L) 190.0(167.7~214.5) 104.0(67.0~92.0) <0.001 178.0(145.8~191.8) 101.0(59.0~157.0) <0.001
    WBC(×109/L) 14.1(10.9~15.9) 9.0(7.0~13.1) 0.040 10.1(6.2~13.7) 7.7(5.0~10.6) 0.126
    PCT(ng/mL) 4.6(2.3~10.4) 1.6(0.9~3.1) 0.001 1.6(1.2~2.5) 1.1(0.5~1.9) <0.001
    CRP(mg/L) 35.4(12.9~61.3) 20.6(9.7~35.0) 0.011 17.5(9.7~37.1) 6.5(3.2~14.5) <0.001
    NLR 13.8(5.6~21.4) 6.8(3.7~13.6) 0.006 10.1(4.2~16.2) 6.5(2.9~12.2) 0.329
    Hb(g/L) 110(92~122) 78(72~92) <0.001 114(88~129) 89(77~110) <0.001
    PLT(×109/L) 82(52~133) 40(28~80) 0.002 83(49~122) 56(37~83) 0.001
    eGFR(mL-1·min-1·1.73m-2 31.5(29.1~49.7) 79.0(59.7~106.6) <0.001 38.0(31.0~46.8) 43.5(27.9~84.3) 0.001
    MELD-Na评分 38.6(29.1~49.7) 22.5(15.5~31.7) <0.001 33.2(28.3~40.8) 28.6(18.1~35.2) <0.001
    下载: 导出CSV

    表  2  两组生化指标差值组间比较

    Table  2.   Inter-group comparison of the difference in biochemical parameters between the two groups

    指标 观察组(n=31) 对照组(n=59) Z P
    TBil(µmol/L) 162.7(53.7~225.1) 121.8(63.6~193.4) -0.548 0.584
    ALT(U/L) 63.8(11.0~139.8) 34.8(4.7~253.5) -0.195 0.845
    AST(U/L) 189.7(54.9~317.4) 73.3(21.1~256.1) -2.085 0.037
    PTA(%) -7.8(-15.8~0.9) -3.0(-11.9~3.7) -1.057 0.290
    Scr(µmol/L) 82.1(66.5~128.8) 27.0(-21.0~70.0) -4.479 <0.001
    PCT(ng/mL) 1.34(0.5~9.5) 0.3(-0.2~1.7) -2.866 0.004
    CRP(mg/L) 11.9(-2.1~36.4) 8.7(3.1~20.8) -0.785 0.432
    Hb(g/L) 26(13~38) 15(2~28) -2.072 0.038
    PLT(×109/L) 58(3~90) 14(-2~47) -2.085 0.037
    eGFR(mL-1·min-1·1.73m-2 -42.5(-69.8~-26.2) -7.7(-49.5~5.9) -3.571 <0.001
    MELD-Na评分 16.5(4.1~20.5) 6.3(1.1~16.2) -2.662 0.008
    下载: 导出CSV
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