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经选择性血浆分离器行人工肝治疗低血小板计数慢加急性肝衰竭患者的效果及安全性分析

李守娟 王丽 周明 吴蓓 王磊 段萌 廖洪帆 胡瑞晴 胡朝霞 朱丽 胡娟

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经选择性血浆分离器行人工肝治疗低血小板计数慢加急性肝衰竭患者的效果及安全性分析

DOI: 10.12449/JCH240619
基金项目: 

成都市卫生健康委员会 (2021435);

中国公共卫生联盟课题(第一批) (GWLM202037)

伦理学声明: 本研究方案分别于2020年11月23日、2021年9月13日经由成都市公共卫生临床医疗中心医学伦理委员会审批,批号分别为:PJ-K2020-58-01、PJ-K2021-38-01,所有治疗和检测均获得患者或家属知情同意,均签署知情同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:李守娟负责设计论文框架,拟定写作思路,负责数据收集,统计学分析,绘制图表,起草论文;周明、吴蓓、王磊、段萌、廖洪帆、胡瑞晴、胡朝霞、朱丽、胡娟负责病例选择和临床资料整理;王丽负责文章的审阅和修改。
详细信息
    通信作者:

    李守娟, lishoujuan2005@126.com (ORCID: 0009-0000-6382-0346)

Efficacy and safety of artificial liver support therapy with a selective plasma separator in low-platelet count patients with acute-on-chronic liver failure

Research funding: 

Health Commission of Chengdu Municipality (2021435);

Chinese Public Health Alliance Project (first batch) (GWLM202037)

More Information
  • 摘要:   目的  对不同分层血小板计数的慢加急性肝衰竭(ACLF)患者采用Evacure-4A膜型选择性血浆分离器行人工肝治疗,观察其疗效、安全性及对血小板的影响。  方法  选取2021年1月—2023年5月于成都市公共卫生临床医疗中心肝病科住院的302例低血小板计数ACLF患者,根据血小板计数将其分为3组:A组(血小板计数:25×109/L~50×109/L)101例;B组(血小板计数:51×109/L~80×109/L)98例;C组(血小板计数:81×109/L~100×109/L)103例。所有患者在内科治疗的基础上根据病情给予不同模式人工肝治疗:包括血浆灌流联合血浆置换、双重血浆分子吸附联合血浆置换、胆红素吸附联合血浆置换。计量资料各组治疗前后比较采用配对t检验,多组间比较采用方差分析,进一步两两比较采用SNK-q检验。计数资料多组间比较采用χ2检验。  结果  88.74%(268/302)患者人工肝治疗后临床症状呈不同程度改善。治疗后各组患者肝功能ALT(t值分别为14.755、21.614、15.965)、AST(t值分别为11.491、19.301、3.919)、TBil(t值分别为19.182、17.486、21.75)较治疗前均呈不同程度下降(P值均<0.001);INR呈不同程度缩短(t值分别为3.497、3.327、4.358,P值均<0.05)。使用Evacure-4A膜型选择性血浆分离器行人工肝治疗后,A、B、C组血小板计数分别由治疗前(37.73±6.27)×109/L、(66.97±7.64)×109/L、(93.82±5.38)×109/L降至治疗后(36.59±7.96)×109/L、(62.59±7.37)×109/L、(85.99±12.49)×109/L,其中B、C组治疗前后比较均有统计学差异(t值分别为12.993、8.240,P值均<0.001),A组治疗前后比较无统计学差异(P>0.05)。3组间人工肝治疗中不良反应的发生率差异无统计学意义(P>0.05)。  结论  人工肝治疗能改善ACLF患者的肝功能及INR,使用Evacure-4A膜型选择性血浆分离器在人工肝治疗过程中对血小板的影响较小,治疗血小板明显低下ACLF患者是安全的。

     

  • 表  1  血小板计数不同分层ACLF患者的一般资料比较

    Table  1.   Comparison of general data of ACLF patients with different levels of platelet count

    组别 例数 男/女(例) 年龄(岁) INR Alb(g/L)
    A组 101 82/19 51.75±11.38 2.11±0.71 27.79±3.76
    B组 98 75/23 51.53±10.96 1.98±0.46 28.79±3.61
    C组 103 81/22 50.72±12.49 2.11±0.77 28.97±3.59
    统计值 χ 2=0.649 F=0.223 F=1.221 F=3.058
    P 0.723 0.804 0.361 0.060
    下载: 导出CSV

    表  2  血小板计数不同分层ACLF患者人工肝治疗前后肝功能、凝血、血小板变化

    Table  2.   Changes of liver function, blood coagulation and platelet count in patients with ACLF before and after artificial liver treatment

    分组 例数 ALT(U/L) AST(U/L) Alb(g/L) TBil(μmol/L) INR 血小板计数(×109/L)
    A组 101
    治疗前 1.97±0.34 2.05±0.33 27.79±3.76 322.30±149.56 2.11±0.71 37.73±6.27
    治疗后 1.78±0.28 1.88±0.31 25.71±2.79 197.25±103.20 1.91±0.66 36.59±7.96
    t 14.755 11.491 9.650 19.182 3.497 1.820
    P <0.001 <0.001 <0.001 <0.001 0.001 0.072
    B组 98
    治疗前 2.06±0.43 2.09±0.37 28.79±3.61 262.28±113.56 1.98±0.46 66.97±7.64
    治疗后 1.87±0.38 1.90±0.32 25.78±3.89 159.23±78.79 1.86±0.56 62.59±7.37
    t 21.614 19.301 7.878 17.486 3.327 12.993
    P <0.001 <0.001 <0.001 <0.001 0.001 <0.001
    C组 103
    治疗前 2.37±0.50 2.31±0.44 28.97±3.59 311.16±128.73 2.11±0.77 93.82±5.38
    治疗后 2.11±0.44 2.07±0.36 26.26±3.27 183.96±96.01 1.89±0.80 85.99±12.49
    t 15.965 13.919 8.045 21.750 4.358 8.240
    P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
    下载: 导出CSV
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