A Retrospective Study Of The Effect Of Plasma Exchange In Treatment Of The Liver Failure

Objective: To explore the clinical dfficacy of plasma exchange (PE) in the treatmentof liver failure. Methods: The patient who were diagnosed liver failure, werecollected in our unit during January2008to December2011consecutively. All thepatients reeived similar pharmacological manipulation sccording to one and the sameprotocol but were divided into treatment group with plasma exchange and controlgroup without plasma exchange. The total bilirubin(TBIL), albumin(ALB), alanineaminotransferase(ALT), aspartate aminotransferase(AST), cholinesterase(CHE),prothrombin time(PT) and international normalized ratio(PT-INR) in the bloodwere ecamined before and after treatment, compared by relevant statistical methods.The mortality rate comparisons between different groups all use chi-square test.Results: Totally223patients with liver failure were collected into this study, malewere177, female were46. Treatment group were53patients, male were42, femalewere11, were enrolled in total124times of PE. Control group were170patients,male were135, female were35. The TBIL, PT,PT-INR were decreased from (X±S)(433.63±121.64)μmol/L,(30.61±11.3) seconds and2.71±1.21to (268.37±87.38)μmol/L,(20.28±3.69) seconds and1.65±0.29after plasma exchangerespectively (P<0.001). The changes of TBIL, ALB, ALT, AST, CHE, PT and PT-INRwere significantly different between before and after plasma exchange respectively.After the plasma exchange, the decline of TBIL was (32.78±21.42)%,(45.99±18.99)%respectively in who were effective and invalid in treatment group and weresignificantly different（P<0.05）. The mortality rate was lower who percentage ofTBIL decreased more than46%. Cases of PE treatment, the mortality rate of MELD <20was lower the MELD>20.The mortality rate of all psrents was60.9%(135/223).The mortality rate was58.5%(31/53) in treatment group, and61.2%(104/170) incontrol group. And the mortality rate were no significantly different betweentreatment group and control group (P=0.727). After matching of gender, age andmodel for end-stage liver disease (MELD), there were48patients in control groupmatching with48patients in treatment group. The differences of gender, age, TBILand PT were no significantly different by Mann-Whitney U test and Sign test. Aftermatching, the mortality rate was58.3%(28/48) in treatment group, and70.8%(34/48)in treatment group, and the mortality rate were no significantly different betweentreatment group and control group (P=0.200). After matching, PE can improve themortality of medium-term and MELD<20of chronic-subacute on liver failure. Thehypokalemia of adverse reaction were more common then allergic reaction, bleedingand nausea during treatment in the plasma exchange. Conclusions: The plasmaexchange can improve the clinical symptoms and biochemical index in the blood, andmaybe can reduce mortality rate of the patients with liver failure, is an effectiveartificial liver support system. There is a relationship between the level of the PT andprognosis of liver failure. Early intervention treatment of PE or other liver failure,liver failure prognosis may be better.