Comparative Study Of Efficacy Of PE And DPMAS In Management Of Hyperbilirubinemia

Ojectives:The aim of this study was to compare the clinical efficacy of plasma exchange (PE)with double plasma molecular adsorption (DPMAS) for hyperbilirubinemia and to study the best artificial liver treatment for hyperbilirubinemia. To compare the clinical efficacy of plasma exchange (PE) and double plasma molecular adsorption system(DPMAS) in the treatment of patients with hepatic failure that from hyperbilirubinemia group, and to study the best artificial liver treatment for liver failure.These patients received 262 rounds artificial liver treatment.Methods:From 1st July 2015 to 31st January 2017,we evaluated 90 cases ofhyperbilirubinemia patients who were treated with artificial liver in the Second Affiliated Hospital of Kunming Medical University .All patients were on the basis of standard medical treatment received artificial liver treatment(PE or DPMAS).These patients received 262 rounds artificial liver treatment.According to the different pattern of artificial liver, patients with hyperbilirubinemia were divided into two groups: 45 patients in the PE treatment group and 45 patients in the DPMAS treatment group. The patients from PE group received 142 rounds artificial liver treatment.The patients from DPMAS group received 120 rounds artificial liver treatment. We Compared the baseline data (the total bilirubin before artificial liver surgery ,age, artificial liver type) and treatment effect between the two groups. We compared the evolution of liver function, coagulation function, Three indicators of acute infection, blood cell analysis, renal function and electrolyte after treatment between the two groups, record treatment-related adverse events.There were 23 patients who were liver failure patients from hyperbilirubinemia group received PE treatment. There were 14 liver failure patient received DPMAS treatment .We compared the evolution of liver function, coagulation function, Three indicators of acute infection, blood cell analysis, renal function and electrolyte after treatment between the PE group and the DPMAS group,Record treatment-related adverse events.Results1.The comparison betweeen the liver function berore artificial liver operation and the liver function after artificial liver operation: ?The albumin(ALB), globulin(GLO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL),direct bilirubin (DBIL) and indirect bilirubin (IBIL) which was drawing from patients after the artificial liver operation immediately were decreasing compared with these which berore the artificial liver operation.The rate of decline of ALB was statistically significant (p <0.05). The comparison of decline rate between that before artificial liver operation and after operation:The rate of ALB in PE group was higher than that in DPMAS group, and the other indexes were not statistically significant.? The comparison between preoperative liver function and that from the artificial liver operation 2-3 days later,the preoperative liver function and that from the artificial liver operation5-7 days later,the preoperative liver function and that from the artificial liver operation 12-14 days later:the transaminase, obstructive enzyme,total bilirubin, total bile acid (TBA) after artificial liver operationwere lower than before surgery, the rate of decline between the two groups were no significant difference .The DPMAS group PAB drop rate> PE group PAB rate of decline.2.The comparison betweeen the coagulation function berore artificial liver operation and the coagulation function after artificial liver operation: PE group:the levels of prothrombin time (PT) and international standardized ratio (INR) were lower than those before operation (P <0.01). The fibrinogen (FIB) increased 2-3 days after operation (P <0.01)), the remaining indicators were not statistically significant.DPMAS group: The coagulation function-related indicators after artificial liver were not statistically different compared with before the operation.The comparisn of the reduction rate of coagulation function in two groups :the reduction rate of PT,INR was statistically significant (P <0.05), and the decrease rate of PE group was higher.3.The comparison between the three cases of acute infection berore artificial liver operation and the three cases of acute infection after artificial liver operationafter operation: The changes trend of the three cases of acute infection in PE group and DPMAS group were the same, and the PCT and hs-CRP in PE group and DPMAS group were statistically significant, the PCT, hs-CRP after artificial liver operation were lower than before operation.Comparison of the three groups of acute infection rate of decline: the indicators were not statistically significant.4.The comparison betweeen the renal function berore artificial liver operation and the coagulation function after artificial liver operation:The comparison betweeen the renal function berore artificial liver operation and the coagulation function 2-3 days later after artificial liver operation:PE group: CREA was statistically significant(P <0.01). Postoperative CREA decreased compared with preoperative.DPMAS group:urea (BUN), creatinine (CREA) were not statistically significant(P>0.05).5.The comparison betweeen the blood cell analysis berore artificial liver operation and the blood cell analysis after artificial liver operation:PE group:the levels of Neutrophils (NEU%), red blood cells (RBC), hemoglobin (HGB), platelets (PLT)were statistically significant(P <0.05) ,the NEU% that after artificial liver operation was risen comparison with before the operation,RBC?HGB?PLT were decreasen.WBC was no statistically significant(P>0.05).DPMAS group:All indicators were not statistically different.6.The comparison betweeen the electrolyte berore artificial liver operation and the electrolyte after artificial liver operation:The comparison betweeen the electrolyte berore artificial liver operation and the electrolyte 1-2 days later after artificial liver operation:PE group: Potassium ion (K+)after artificial liver operation was risen comparison with the potassium ion before(p<0.05).the Sodium (Na+),chlorine (Cl-), calcium (Ca2+) were statistically significant(p<0.01).the Na+? Cl- after artificial liver operation were risen comparison with the before.the Ca2+ after artificial liver operation was decreasen comparison with the before.DPMAS group: all electrolyte indicators were not statistically significant (P> 0.05).7.The change of liver function, renal function, electrolyte and acute infection which from liver failure group were roughly consistentto those ofhyperbilirubinemia.Conclusion:1 .Whether or not combined with liver failure,PE?DPMAS are effective and safe treatment for hyperbilirubinemia patients. Both PE and DPMAS can reduce the liver enzyme, bilirubin, procalcitonin and high sensitivity C-reactive protein in the short term (2 weeks).2.PE,DPMAS had its own characteristics.PE in improving the coagulation function, renal function is better than DPMAS,the treatment costs are relatively low,but the hemoglobin, platelet in the PE group may declined, mild electrolyte disorder were occured. Though albumin decline rate in the DPMAS group is greater than PE group, but DPMAS had less loss rate of albumn, and less prone to hemoglobin, platelet decline, no electrolyte imbalance.3 .The patient's condition is different,We should choose different artificial liver methodbased on the patient conditions. Thepaiengts who coagulation function is relatively poor, or mild renal impairment, we can choose PEbecause of PE can improve the patient's coagulation function. DPMAS without the use of plasma, risk of blood-bone discrease transmission.For patients with high sensitivity or plasma allergy history,DPMAS is a good choice when plasma is scarce.