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

doi:10.12449/JCH240319

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

文苑,
祝娟娟^, ,

贵州医科大学附属医院感染科，贵阳 550002

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。

详细信息

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

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出版历程
- 收稿日期: 2023-06-10
- 录用日期: 2023-07-24
- 出版日期: 2024-03-20

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

Yuan WEN,
Juanjuan ZHU^{,
,}

Department of Infectious Diseases，The Affiliated Hospital of Guizhou Medical University，Guizhou 550002，China

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

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。
- 慢加急性肝功能衰竭 /
- 急性肾损伤 /
- 血浆置换 /
- 双重血浆分子吸附系统 /
- 连续性肾脏替代疗法
Abstract: Objective To investigate the clinical efficacy of double plasma molecular adsorption system （DPMAS） and sequential plasma exchange （PE） combined with continuous renal replacement therapy （CRRT） in the treatment of patients with acute-on-chronic liver failure （ACLF） and acute kidney injury （AKI）. Methods A retrospective analysis was performed for the clinical data of 90 patients with ACLF and AKI who were hospitalized in The Affiliated Hospital of Guizhou Medical University from January 2019 to December 2022， and according to the method for blood purification， they were divided into DPMAS sequential PE+CRRT group （observation group with 31 patients） and DPMAS sequential PE group （control group with 59 patients）. General data on admission and laboratory markers before and after blood purification were collected from all patients， including hepatic and renal function， coagulation function， and inflammation markers， and estimated glomerular filtration rate （eGFR） and MELD combined with serum sodium concentration （MELD-Na） score were calculated. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data within each group before and after treatment， and the Mann-Whitney U test was used for comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Results The observation group had a significantly higher response rate than the control group ［48.4% （15/31） vs 27.1% （16/59）， χ²=4.071， P=0.044］. The methods for blood purification in both groups could effectively improve total bilirubin， alanine aminotransferase， aspartate aminotransferase （AST）， prothrombin time activity， serum creatinine （Scr）， procalcitonin （PCT）， C-reactive protein， eGFR， and MELD-Na score （all P<0.05）， and both groups had significant reductions in platelet count （PLT） and hemoglobin （Hb） after treatment （all P<0.05）， while there were no significant changes in blood urea nitrogen， albumin， and international normalized ratio after treatment （all P>0.05）. There were significant differences between the two groups in the changes in AST， Scr， PCT， eGFR， MELD-Na score， Hb， and PLT after treatment （all P<0.05）. Conclusion DPMAS sequential PE combined with CRRT can effectively remove inflammatory mediators， improve renal function， stabilize the internal environment of human body， and achieve a relatively good clinical efficacy.
- Acute-On-Chronic Liver Failure /
- Acute Kidney Injury /
- Plasma Exchange /
- Double Plasma Molecular Adsorption System /
- Continuous Renal Replacement Therapy

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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）
指标	治疗前	治疗后	P值	治疗前	治疗后	P值
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

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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值	P值
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

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