| LBackground and Objectives]Liver failure is a series of clinical syndrome with high mortality characterized by progressive jaundice, blood coagulation dysfunction, hepatic encephalopathy and ascites. Liver failure caused by a variety of factors, leading to dysfunction of the synthesis, detoxification, excretion and biogenesis. Since medical comprehensive treatment lacks of efficient drugs, clinical effect for liver failure is commonly not satisfactory. Liver transplantation is internationally recognized as the effective therapy for patient with liver failure. However, liver transplantation is limited in clinical application because of its high cost, lack of donors and long-term need of immunosuppressive agents after the operation, etc. Thus artificial liver support system came into being as a transient substitute for liver. Plasma exchange and molecular adsorbent recirculating system (MARS) are currently the most widely used artificial liver support systems, which play more and more important role in liver failure treatment. Nevertheless, neither plasma exchange nor MARS showed a satisfactory effect for some liver failure cases, because single artificial liver technique has its own shortcomings and deficiencies. Therefore, a combination of different artificial liver techniques becomes more and more popular.This research was designed to compare the clinical effect of plasma exchange, MARS and combined treatment (plasma exchange combined with MARS) on liver failure. By comparing the effect and adverse reactions of plasma exchange with MARS, we tried to find their respective characteristics. By analyzing the related factors influencing the prognosis of liver failure, we intended to provide basis for individualized artificial treatment on liver failure cases and to help clinicians to select and use artificial liver technique reasonably so as to raise clinical effect of patients with liver failure.[Methods]The data of three hundred patients with liver failure were collected, who were hospitalized in Jinan infectious disease hospital affiliated to Shandong University between January 2013 and December 2015. They were retrospectively divided into plasma exchange group (170 cases), MARS group (56 cases) and combined-group (plasma exchange combined with MARS,74 cases). By comparing the changes of clinical manifestation and serum biochemical indexes after hospitalization, effect of plasma exchange combined with MARS on liver failure was evaluated. Furthermore, the changes of blood routine and serum biochemical indexes after each artificial liver treatment as well as adverse reactions were compared, so as to clarify the characteristics and safety of plasma exchange and MARS. A database was established and then the entire set of data was processed by SPSS 17.0 statistical software. T test and analysis of variance were accordingly used for measurement data with normal distribution. Chi-square test and Fishers exact probability method were used for enumeration data. The independent risk factors influencing the prognosis of liver failure were determined by logistic regression analysis and P<0.05 was considered as statistical difference.[Results]1. Comparison of clinical effects of different artificial liver treatmentThe clinical symptoms such as fatigue, anorexia, abdominal swelling, jaundice and serum biochemical indexes were improved after artificial liver treatment in all three groups. The total effective rate of the 300 cases was 54.0%, and the effect rates of plasma exchange, MARS and combined-group were 49.4%,48.2% and 68.9% respectively. The effect rate of combined-group was higher than plasma exchange and MARS groups (P<0.05).2. Comparison of clinical effect for different clinical types of liver failureAccording to liver failure classification standards,300 patients with liver failure were divided into 3 groups, acute liver failure (28 cases), subacute/acute-on-chronic liver failure (220 cases) and chronic liver failure (52 cases). The effective rates of the 3 groups were 39.3%,57.7% and 46.2% respectively after artificial liver and internal medical comprehensive treatments. Data analysis had no significant difference (X2=4.960, P>0.05). The effect among plasma exchange, MARS and combined treatment for different liver failure types were also not statistically different (P>0.05).3. Comparison of clinical effects for different stages of liver failureSubacute/acute-on-chronic liver failure included early stage (79 cases), middle stage (96 cases) and late stage (45 cases). The effective rates of the 3 stages were 83.5%,50% and 28.9% respectively after artificial liver and internal medical comprehensive treatments. Data analysis had no significant difference (P<0.05). The result showed that the effect of artificial treatment had a close relationship to the stages of liver failure, the highest effect occurred at early stage and the lowest effect at late stage. The effects among plasma exchange, MARS and combined treatment for different liver failure stages were statistically different (P<0.05). For cases at middle stage of liver failure, the combined treatment was more effective than plasma exchange and MARS treatment (P<0.05). For cases at early and late stages of liver failure, three methods showed similar clinical effect (no significant difference, P>0.05).4. Comparison the effect and adverse reactions of plasma exchange with MARSThe declines of alanine aminotransferase, aspartate aminotransferase and total bilirubin, and the rise of prothrombin activity and albumin were significantly greater after plasma exchange than MARS treatment (P＜0.05). Nevertheless, the declines of ammonia, creatinine and urea nitrogen in blood were significantly higher after MARS treatment than plasma exchange. Total cholesterol slightly increased after nether plasma exchange or MARS treatment. However, the levels of change after nether plasma exchange or MARS treatment were not statistically different (P>0.05). Red blood cells, white blood cells and platelet all had reduced after nether plasma exchange or MARS treatment. Decreases of red blood cell and platelet were more obvious after MARS treatment than plasma exchange (P＜0.01). Decrease of peripheral white blood cells were very slight after nether plasma exchange or MARS treatment (.P>0.05). Restoring normal rates of abnormal sodium, potassium and chloride were significantly higher after MARS treatment than plasma exchange (P<0.01). Adverse reactions of plasma exchange and MARS treatment were compared and analyzed. It showed that the incidence of adverse reactions such as skin rash, chills and limb numbness were more common during and after plasma exchange, as compared to MARS treatment (P＜0.05). While local bleeding phenomena including nasal bleeding, gums bleeding and ecchymosis around intubation were lower in plasma exchange than MARS treatment (P<0.05).5. Prognostic factors analysis The results of logistic regression analysis showed that hospital stay, total bilirubin, albumin, total cholesterol, prothrombin activity, alpha fetoprotein, and hepatorenal syndrome played significantly roles on the prognosis and were independent risk factors influencing the prognosis of liver failure.[Conclusion]1. Plasma exchange and MARS treatment were both effective for patients with liver failure to some extent. The effect of combined treatment was superior to single application of Plasma exchange or MARS treatment.2. The effect of artificial liver treatment had a close relationship to the stages of liver failure, early stage had the highest effective rate, indicating that artificial liver treatment should be applied to patient with liver failure as soon as possible.3. Plasma exchange and MARS treatments had different advantages and shortcomings on liver failure. Plasma exchange was suitable for patients with blood coagulation dysfunction and no obvious hepatic encephalopathy. MARS treatment was more suitable for patients with renal insufficiency, electrolyte disorder and obvious hepatic encephalopathy.4. Hospital stay, total bilirubin, albumin, total cholesterol, prothrombin activity, alpha fetoprotein and hepatorenal syndrome were independent factors influencing the prognosis of liver failure. |
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