The Influence Of Double Plasma Molecular Adsorption System Combined With Partial Plasma Exchange On The Short-term Survival Rate With Acute On Chronic Liver Failure And The Relationship Between Traditional Chinese Medicine Syndrome Types And Prognosis Of

Objective: To explore the effect of DPMAS combined with simple plasma exchange on the short-term survival rate of patients with ACLF and the relationship between TCM Syndrome types and prognosis.Methods: Data from fifty-three patients with chronic acute liver failure diagnosed in the inpatient department of Ruikang Hospital of Guangxi University of Traditional Chinese Medicine between January 2013 and June2019 were retrospectively collected.The population was differentiated according to the selected treatment plan,and the DPMAS was chosen,combined with partial plasma exchange artificial liver treatment plan,as the treatment group;meanwhile,the simple plasma exchange artificial liver treatment plan was selected as the control group.Among them,there were 30 cases in the treatment group and 23 cases in the control group.The basic information was recorded,including TCM syndrome types and the related serum biochemical parameters of the two patient groups.The clinical data of all ACLF patients were statistically analyzed using Excel and SPSS19.0,and the changes in related serum biochemical parameters,clinical symptoms,and signs before and after treatment were compared between the two groups.Kaplan-Meier survival analysis was used to analyze the cumulative survivalrates of patients at 4 weeks and 12 weeks after the two models of artificial liver treatment.Univariate analysis was performed on some influential factors of clinical prognosis in patients with ACLF.Statistical analysis was conducted to assess the impact of the different times of artificial liver treatment on clinical prognosis.At the same time,the distribution of different TCM syndrome types in different stages of ACLF,clinical prognosis and MELD scores were compared to explore the relationship between different TCM syndrome types and clinical prognosis of ACLF.Results:(1)There were no significant differences in age,sex,liver failure stage,etiology,liver function,blood routine and electrolyte before treatment.(2)After treatment,TBIL,DBIL,ALB,PT,PLT,ALT,AST and Ca in the two groups decreased significantly(P<0.05).There were significant differences in TBIL,DBIL,ALB,WBC,PT and Ca between the two groups after treatment(P<0.05),and the decrease of TBIL and ALB was more obvious in the treatment group than that in the control group.(3)After 4 weeks of treatment,the proportion of clinical symptoms and signs such as yellow skin staining,weakness,poor appetite,abdominal distension,ascites,less urine and ecchymosis was significantly lower in both groups than before treatment(p<0.05).(4)When the two groups were followed up for 12 weeks after treatment,there was no significant difference between the two groups(P>0.05).(5)The 4-week cumulative survival rates were 86.96% and 96.67%,and the12-week follow-up cumulative survival rates were 86.67% and 69.56%,respectively.There was no significant difference between the two groups(P>0.05).(6)The TBIL,INR,CR and MELD of 11 patients in the death group after treatment were significantly higher than those of the other 42 patients in thesurvival group(P<0.05),while ALB and AFP were lower than those in the survival group(P<0.05).However,there was no significant difference in sex(male),PLT,ALT,AST and TG between the two groups(P>0.05).The MELD score of 53 patients at admission was used as the grouping criterion.The results showed that the MELD score of 30-39 group(100%)was higher than that of 20-29 group(13%)and 10-19 group(0%).(7)The survival rates of patients with ACLF treated once,twice,three times and more were 75%(6/8),85.7%(18/21),80%(8/10)and 71.4%(10/14),respectively.There was no significant difference in clinical prognosis among different times of artificial liver therapy(P>0.05).(8)There was significant difference in clinical prognosis of ACLF among different TCM syndrome types(P<0.05).The survival rate of Damp-heat accumulation syndrome was higher than that of Yin deficiency of liver and kidney and Yang deficiency of spleen and kidney;the death rate of Yang deficiency of spleen and kidney was higher than that of other two syndrome types.There was significant difference between ACLF staging and different TCM syndrome types(P<0.05).There was significant difference in MELD score among different TCM syndrome types(P<0.05).Conclusions:(1)DPMAS combined with partial plasma exchange and simple plasma exchange can significantly improve the blood biochemical parameters,clinical symptoms and signs of patients with ACLF.The former was better than the latter in its ability to remove bilirubin,but there was no significant difference in the short-term survival between the two groups.(2)TBIL,ALB,INR,CR,MELD,AFP may be related to the prognosis of patients with ACLF.(3)Compared with other TCM syndromes,the survival rate of ACLF is higher in the differentiation of damp-heat accumulation syndrome,and thedeath rate is higher in the differentiation of spleen-kidney yang deficiency syndrome;this suggests that the TCM syndrome may be related to the prognosis of ACLF.