The Effect Of Plasma Exchange And Double Plasma Molecules Adsorption System In The Treatment Of Liver Failure

Research BackgroundLiver failure,which is caused by various factors respectively or simultaneously,characterizing a serious dysfunction of the liver structure and function,manifests the dysfunction of synthetic,metabolic,detoxification and other serious disorders,and performs a clinical syndrome of hemorrhage,infection,jaundice,hepatic encephalopathy and ascites.Although the specific mechanism is still unclear,the"immune injury-ischemia hypoxia-endotoxemia" mechanism is considered to play an important role in the occurrence and the development of liver failure.Traditionally,the liver has been regarded as a place to participate in metabolism,nutrition and detoxification,however,it Currently has been regarded as a complex immune organ,in which the immune cells including:kupffer cells,hepatic stellate cells,NK cells,liver type 2 natural lymphoid cells,mucus-related constant T cells,etc.Simultaneously the liver has a special blood supply system,which is consisted of hepatic artery and the portal vein,and the former occupies about 25%,the latter about 75%.Therefore the liver has been attacked by a serious antigens,being from food and symbiotic bacteria.Normally,the PAMPs(pathogen-associated molecular patterns,PAMPs)and DAMPs(damage-associated molecular patterns,DAMPs),which is from symbiotic bacteria and produced by senescent and necrotic cells respectively,are recognized by the pattern recognition receptors(PRRs),being produced by liver cells and kupffer cells,and are removed and degraded in the liver,and the course is named as immune tolerance.At the same time,the liver also play a function of immune surveillance for pathogenic pathogens and malignant cells,etc.Although the metabolic and tissue reconstruction activities are going in a healthy liver constantly,the body produces a controlled and continuous inflammatory response through a complex and strict regulation.The parenchyma cells and non-parenchyma cells reduce when the structure and function of liver is damaged by a complex pathogenic factors or inducements,which leading to a decline in capacity of the clearing antigen.In the early phase of liver failure,mass signal pathways of cytokines interact mutually,which result excessive activation of hepatic and circulatory immune cells,producing mass acute phase proteins,cytokines,and complements instantaneously.These excessive activation of immune action result an immune disorder of the liver locally and overall body through disbalancing pro-inflammatory and anti-inflammatory.The chronic inflammation,autoimmunity,and tumor occur with a failure of clearing antigens and inflammation effectively,which is related to chronic pathological inflammation and homeostasis disorder,and makes liver occur fibrosis and liver cirrhosis gradually and hepatic failure eventually.Currently,liver transplantation as one of the most efficient measurements to cure hepatic failure.However,it has been restricted by a state,including the lack of donor of liver,complications after transplantation,long-term using of immunosuppressor,and expensive charge,etc.Hence,comprehensive medical therapy combined artificial liver system is a common approach of hepatic failure.Double plasma molecules system(DPMAS)appearing recently,has been regarded as an effective approach to clear the bilirubin and cytokines by the bilirubin adsorption column BS330 and neutral resin structure of HA330-II.ObjectiveTo compare the effect of plasma exchange and dual plasma molecular adsorption system in the treatment of liver failure respectively and combined,including clinical curative effect,survival rate,and the factors on short term survival.MethodsThe clinical data of 179 liver patients is collected from the first affiliated hospital of zhengzhou university from June 2018 to October 2019.All patients are treated by a comprehensive medical therapy fundamentally,and 78 patients accept plasma exchange therapy(A group),56 patients accept plasma exchange and double plasma molecular adsorption system therapy(B group),45 patients accept double plasma molecular adsorption system therapy(C group).The clinical data,including the general information,blood regular test,liver function,electrolyte,blood coagulation function inflammatory cytokines,imaging data,and the short-term suvival rate,are given a statistical disposition by SPSS 21.0 software.Results1.Clinicl symptoms The clinical symptoms among 3 groups,including fatigue,abdominal distension,anorexia,nausea,etc,are improved respectively after the treatment,and the improvement rates are respectively 82.0%,83.9%,80.0%.The difference has no significance among 3 groups(χ2=0.263,P=0.877).2.Laboratory results The comparison of laboratory results occurs between after the treatment within 24h and baseline value:In A group,the levels of ALT,AST,TBIL,DBIL and PT have been reduced,the levels of ALB,PLT,Na+and PTA have been enhanced,the differences have statistical significance(all the P value are under 0.05).In B group,the levels of ALT,AST,TBIL,DBIL,PT,TNF-α,IL-6 and IL-8 have been reduced,and the levels of ALB,PLT and Na+have been enhanced,the differences have statistical significance(all the P value are under 0.05),however the change of PTA has no statistical significance(the P value is equal to 0.338).In C group,the levels of ALT,AST,TBIL,DBIL,TNF-α,IL-6 and IL-8 have been reduced,and the levels of PLT and Na+have been enhanced,the differences have statistical significance(all the P value are under 0.05),however,the changes of ALB,PT and PTA has no statistical significance(the P value is equal to 0.849,0.059 and 0.842 respectively).The comparison occurs about the difference of the laboratory data among 3 groups:The differences of ALT,AST,IL-6 and IL-8 have no statistical significance(all the P value are above 0.05),and the differences of TBIL,DBIL,ALB,PLT,Na+,PT,PTA and TNF-α have statistical significance(all the P value are under 0.05).Pairwise comparison has been conducted for P under 0.05,the difference of TBIL:group B is higher than group A,and the P value is equal to 0.008.The difference of DBIL:group B is higher than group C,and group C is higher than group A,and the P value are under 0.05.The difference of ALB:group A and group B are higher than group C respectively,and the P value are under 0.001.The difference of PLT:group B and group C are higher than group A respectively,and the P value are under 0.05.The difference of Na+:group C is higher than group A,and the P value is equal to 0.004.The difference of PT:group A is higher than group B and group C respectively,and the P value are under 0.001.The difference of PTA:group A is higher than group B and group C respectively,and the P value are under 0.001,and group B is higher than group C,and the P value is equal to 0.005.The difference of TNF-α:group C is higher than group B,and the P value is under 0.001.3.Clinical effect The comparison of overall efficiency among 3 groups has no statistical significance,and the Χ 2 and P value is equal to 2.691 and 0.260 respectively.4.Survival rate The difference of survival rates about 2 weeks and 4 weeks among 3 groups has no statistical significance,and the P values are above 0.05.The difference of survival rates about 8 weeks has statistical significance,and the P value is equal to 0.010,and the survival rate of group B are higher than group A and group C,the P value are respectively equal to 0.005 and 0.015,however,the survival rate between group A and group C has no statistical significance,and the P value is equal to 0.978.5.Prognostic factors The independent risk factors affecting the 8-week survival rate are respectively the serum level of total bilirubin,PTA and IL-6.Conclusions1.The independent risk factors affecting the 8-week survival rate are respectively the serum level of total bilirubin,PTA and IL-6.2.The plasma exchange combined double plasma molecules adsorption system can reduce the serum levels of IL-6 and IL-8 more effectively than the single using of the latter.3.The survival rate of 8 weeks using plasma exchange combined double plasma molecules adsorption system are higher than the respective using,and the difference between the respective using has no statistical significance.