The Clinical Study Of Double Plasma Molecular Adsorption System On Treatment With Liver Failure

Objective Purposed to evaluate the clinical effectiveness on the liver failure by Double plasma molecular adsorption systems comparing with plasma exchange(PE),seeking a safe and effective approach to liver support system with limited plasma resources.Methods The study was evaluated on 42 patients who were diagnosed with liver failure hospitalized in China-Japan Union Hospital,Jilin University Medical Department from August 2012 to December 2017,which all patients were treated by medical comprehensive therapy combined with artificial liver support therapy(DPMAS or PE treatment)for a total of 141 times.It was divided into two groups including Double plasma molecular adsorption system in the treatment group(DPMAS Group)and plasma exchange group(PE Group),which 23 patients were treated by Double plasma molecular adsorption system for 79 times in the DPMAS group besides 19 patients treated by line plasma exchange for 62 times in the PE group.(1)Comparison the clinical data on two groups of patients at admission,including age,gender,clinical manifestations,situation awareness,liver function and blood coagulation function of the situation.(2)Comparison changes of laboratory parameters on the two groups after treatment with artificial liver treatment including liver function,blood coagulation function,renal function,blood ammonia,blood ammonia,ions and routine blood test,partial level of inflammatory factors.(3)Comparison the improvement degree of clinical symptom on the two groups.(4)Comparison adverse reactions on the two groups during treatment and after treatment in patients.Results 1.Comparison the levels of liver function and blood ammonia before or after operation between the DPMAS group and PE group: the levels of liver function including with total bilirubin(TBIL),direct bilirubin(DBIL),indirect(IBIL),bile acid(TBA),aspartate amino-converting enzymes(AST),Alanine Aminotransferase(ALT),albumin(ALB),globulin(GLB)and blood ammonia were decreased(P<0.05)after treatment in the DPMAS group and PE group patients,it had no significantly statistics effect on the loss rate(P>0.05)between the DPMAS group and the PE group including TBIL,DBIL,IBIL,AST,ALT and NH3,meanwhile therate of decline of TBA,ALB,GLB in the DPMAS groups was smaller than the PE group.2.Comparison the levels of tumor Necrosis Factor ?(TNF-?)and high sensitive C-reactive protein(hs-CRP)in the DPMAS group and PE group before or after: the levels of TNF-? and hs-CRP were decreased after treatment in the DPMAS group,as well it showed no significant effect in the PE group,meanwhile,the descent rate of TNF-? and hs-CRP in the DPMAS group was more than the PE group(P<0.01).3.Comparison blood count and electrolytes in the DPMAS group and PE group before or after: the level of blood count and electrolytes showed no significant effect in the DPMAS group(P>0.05),however,the level of sodium and chlorine was increased after treatment in the PE group,meanwhile the level of calcium was decreased.The drop-rate of red blood cell count(RBC),hemoglobin(HB)and blood platelet count(PLT)in the DPMAS group was less than the PE group(P<0.01);negative rate of descent for sodium ion(Na+)and chloride ion Cl-in the PE group was less than the DPMAS group(P<0.01);it showed no significant effect on the drop-rate of white blood cell count(WBC)and potassium ions(K+)between two post-operation groups(P>0.05).4.Comparison coagulation function in the DPMAS group and PE group before or after: it showed no significant difference of the blood coagulation function in DPMAS group.The level of prothrombin time(PT)(P<0.01)and international normalized ratio(INR)(P<0.05)were decreased after treatment in the PE group,whereas,the level of fibrinogen was increased(P<0.01).The decreased rate of PT(P<0.01)and INR(P<0.05)in DPMAS group was less than the PE group post-operation for 2-3 days;the decline rate of FIB was negative in the PE group,less than the DPMAS group(P<0.05);the decline rate of rest index didn't was not statistically significant.5.After treatment,patients' symptoms of two groups improved comparing with pretreatment,however,it had no significant difference in rate improvement(P>0.05).6.They were all showed dropping in blood pressure,local bleeding,fever,rashes and other side effects in the two groups,conclusion the overall incidence of adverse reactions in the DPMAS group(the ratio of all patients with adverse reactions in all patients in the group)and the incidence of fever and rash were lower than those in the PE group,but there was no statistical difference(P>0.05);the incidenceof bleeding was lower in the DPMAS group,but there was no statistical difference(P>0.05).Conclusion 1.Double plasma molecular adsorption systems could significantly eliminate bilirubin in the blood,blood ammonia and toxic substances such as TNF-?,reducing inflammatory reaction,improving liver function in liver failure patients.2.Double plasma molecular adsorption system could improve effectively the clinical symptoms of liver failure patients.3.Treatment with double plasma molecular adsorption system had no effect on levels of blood routine and ion during the treatment process,with less albumin dissipation.4.Double plasma molecular adsorption system was not restricted by plasma with fewer adverse reactions,it could provide a fast,safe and effective therapy.