Clinical Study Of Plasma Exchange Combined With Double Plasma Molecular Adsorption System For Patients With Acute-on-chronic Liver Failure

Objective:Based on the study of plasma exchange(PE)combined with double plasma molecular adsorption system(DPMAS)on the treatment of patients with chronic acute liver failure,The changes of symptoms,signs,laboratory tests and pro-inflammatory cytokines of patients in the three groups treated with PE alone,the same amount of PE combined with DPMAS and the low replacement amount of PE combined with DPMAS before and after different modes of treatment were analyzed and compared,and the recent efficacy was tracked.To analyze and compare the therapeutic effect differences among the three groups treated with PE alone,the same amount of PE combined with DPMAS and the low replacement amount of PE combined with DPMAS,in order to provide clinical guidance for the optimal treatment plan.Methods:.A total of 154 patients with Acute-on-chronic liver failure(ACLF)admitted to the Affiliated Hospital of Affiliated Hospital of Youjiang Medical College for Nationalities from August 2019 to October 2022 were collected.The clinical symptoms,signs,and laboratory indicators of patients treated with PE,half-dose PE+DPMAS,and full-dose PE+DPMAS were recorded before and after treatment,and at 2,4,and 12 weeks after treatment,respectively,as well as the prognosis at 2 and 4 weeks after treatment.SPSS 28.0 software was used for statistical analysis,and t test,Chi-square test and other statistical methods were used to predict,analyze and compare the data differences between the three groups before and after treatment.Results:After treatment,leukocyte(WBC)index of the three groups was increased and alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),serum globulin(GLB),total bilirubin(TBIL),hemoglobin(HGB)and platelet count(PLT)in the three groups were decreased compared with those before treatment and the difference was statistically significant(P<0.05).There was no significant difference in the values of alpha-fetoprotein(AFP)between the three groups before and after treatment(P>0.05).The prothrombin time(PT)in PE group was lower after treatment than before treatment,and the difference was statistically significant(P<0.05).There was no significant difference in the value of prothrombin time(PT)before and after treatment in both low replacement dose PE+DPMAS group and full dose PE+DPMAS group(P>0.05).In the comparison of the differences between the three groups before and after treatment,there was no significant difference in the indexes between the full PE+DPMAS group and the half-dose PE+DPMAS group(P>0.05).There was no significant difference in ALT,AST,GGT,ALP,GLB,HGB,PLT and AFP between PE group and PE+DPMAS group before and after treatment(P>0.05).The TBIL value of the PE+DPMAS group and the PE+DPMAS group was significantly lower than that of the PE group,and the difference was statistically significant(P<0.05).The PT value of the PE group was significantly lower than that of the full PE+DPMAS group and the PE+DPMAS group,and the difference was statistically significant(P<0.05).There was no significant difference in the rate of cure,improvement and non-cure between the groups before treatment and 12-week after treatment(P>0.05).There was no significant difference in 2-week and 4-week and 12-week mortality among the three groups(P>0.05)Conclusion:1)PE group,full PE+DPMAS group and low replacement PE+DPMAS group can decrease liver function indexes of ACLF patients,and there are hemoglobin and platelet loss during treatment.PE group could improve the coagulation function index,but full PE+DPMAS group and low replacement volume PE+DPMAS group could not.None of the three groups could decrease the alpha-fetoprotein.2)The full PE+DPMAS and the low replacement PE+DPMAS can better reduce TBIL,and the PE group has a better effect on improving the coagulation function of patients.3)The three ways of treatment have little effect on the clinical prognosis and short-term mortality of ACLF patients.According to the treatment conditions and individual conditions,the appropriate artificial liver treatment instrument can be selected to achieve the best results.