Clinical Study Of Curative Effect Of Artificial Liver Support System Treatment On The Hepatitis B Related Acute-on-chronic Liver Failure

ObjectiveTo investigate the difference of the therapeutic effect of different artificial liversupport system (ALSS) treatment of hepatitis B related acute-on-chronic liverfailure by retrospective comparative study.Methods119patients with acute-on-chronic hepatitis B liver failure from Wuhan Tongjihospital were treated by ALSS for179times. They were divided into three groups:39cases in plasma bilirubin absorption (PP) group,44cases in plasma exchange (PE)group and36cases plasma bilirubin absorption plus plasma exchange (PP+PE) group.Laboratory tests before and after the treatments and1week after the treatments andthe clinical efficacy after patients leave hospital were recorded, we compared thedifference of laboratory tests and the clinical efficacy in the different group.Result(1)The total bilirubin level is significantly decreased after treatments in thePP+PE groups, clearence rate of the total bilirubin in PP+PE group were60.29%,higher than43.22%in PE group (P＜0.05) and34.72%in PP group（P＜0.05）. After1week of treatment, PP+PE and PE group bilirubin rebound, but still was better thanthat before treatment, descend range of bilirubin lever in PP+PE group is higher than that in PE group (P＞0.05). Direct bilirubin (DBIL) and indirect bilirubin (IBIL)clearance is same in PP+PE and PE groups, but in PP group IBIL clearance rate ishigher than DBIL clearance rate.（2）Bile acid clearance rate in PP+PE group was33%, higher than17%in PE group (P＜0.05),25%in PP group (P＜0.05).（3）Thesymptoms of below hepatic encephalopathy（HE）Ⅱ degrees improved after PP+PEand PE treatment, blood ammonia decreases significantly, decline in proportion wasno statistically significant difference between two groups, and to more than HE Ⅲdegrees, symptoms of HE after ALSS treatment did not improvement, blood ammoniaincreases.（4）Prothrombin activity (PTA) is improved obviously in PE group andPP+PE group, but it is decreased dramatically in PP group and recover after1week.PP+PE and PE group PTA rebound, but still was better than that before treatment.Ascend range of PTA in PP+PE group is higher than that in PE group（P＞0.05）（.5）In PP+PE and PE group, K+change is not obvious, low Na+can correct aftertreatment; In PP group, low Na did not change. Na+rebound back to the front of thetreatment at1week after PP+PE and PE treatment.(6) In PP+PE group, the clinicaleffective rate of patient is63.9%(23/36), higher than52.5%(21/40) in PE group(P＞0.05).ConclusionCompared with PE, PP+PE increased bilirubin and bile acid removal. Comparedwith PP, PP+PE overcome disadvantage of falling of coagulation function, wideningthe scope of application of PP, PP+PE is more suitable for coagulation dysfunction ofliver failure. PP+PE、PE can improve the hyponatremia, PP did not have the treatmentto low Na+.