Clinical Observation Of Plasma Exchange And Bilirubin Adsorption For The Treatment Of113Patients With Liver Failure

Background and objectiveLiver failure is a remarkably rare syndrome with high mortality characterized byprogressively coagulopathy,ascites，jaundice and hepatic encephalopathy due tosevere impairment of liver function. To date, transplantation is the only reliableform.Howerer its clinical application is limited by expensive cost, scarce donors andpostoperative rejection and so on.So peoples try to find the alternative solutions. Artificialliver support system came into being in this context.Plasma exchange is widely used in cliniccurrently. Recently it is prone to combine different technologies with each other.To guide the further treatment and screen the proper patients for artificial liversupport system,this research is designed to analyze the therapeutic effect of plasmaexchange and bilirubin adsorption so as to investigate the predictive factorsinfluencing prognosis of liver failure.Methods113patients with liver failure were collected in the first affiliated hospital ofZhengzhou University between January2010and December2013.These weredivided into artificial liver group and medicine treatment group(control group).Thedatas of clinical symptoms and serum laboratory tests were collected by retrospectiveanalysis. Results1Clinical manifestations Nausea,vomiting,fatigue,abdominal swellingimproved in both groups.Compared to the control group,the ratio of improvement ofartificial liver group was higher (p＜0.05).Howerer, the awake rate of hepatic comahad no significant difference(p＞0.05).2Laboratory tests Compared to the datas before treatment, alanineaminotransferase (ALT)，aspertate aminotransferase(AST), urea nitrogen(BUN) of thepatients combing plasma exchange with bilirubin adsorption decreased(p＜0.05).Prothrombin time（PT）obviously shortened,serum total bilirubin（TBiL）,serumtotal bile acid(TBA), blood ammonia(NH3), serum creatinine(Scr) decreasedevidently(p＜0.01). Serum albumin(ALB),D/T ratio(the ratio of direct to totalbilirubin), platelet(PLT), serum sodium(Na＋)， Alpha Fetal Protein(AFP)，prothrombin time activity(PTA)，triglycerides（TG）increased (p＜0.05).Prealbumin（PA），cholinesterase(AchE), total cholesterol(TC) increased obviously(p＜0.01).The number of white blood cells,D-dimmer(D-D) and C-reactive protein(CRP) hadno significant difference(p＞0.05).3Effect comparison The effective rate was significantly higher in artificialliver group than control group(p＜0.05).The survival rate of acute liver failure,subacute liver failure and chronic liver failure had significant difference neither inartifical liver group nor in control group(p＞0.05). The survival rate of subacute liverfailure in the late stage had also no significant difference between groups(p＞0.05).4Prognostic analysis Age≥50years old, the decrease of prothrombin timeactivity,D/T ratio,Alpha Fetal Protein(AFP),complications(hepatic encephalopathy,gastrointestinal bleeding) and liver atrophy were independent risk factors influencingprognosis of liver failure.Conclusion1For liver failure, therapeutic effect of plasma exchange and bilirubinadsorption was superior to mdicine treatment.2Plasma exchange and bilirubin adsorption can improve clnical symptoms and provide a bridge to liver transplantation of patients with subacute liver failure inlate stage,howerer, not contributed to the survival rate.3Age≥50years-old, the decrease of prothrombin time activity，D/T ratio,Alpha Fetal Protein(AFP), complications(hepatic encephalopathy, gastrointestinalbleeding), liver atrophy were independent risk factors influencing prognosis of liverfailure.