| ObjectiveIn this study,by comparing different combinations(e.g.plasmapheresis(PE),PE combined with plasma perfusion(PP),PE combined with bilirubin adsorption,and PE combined with double plasma molecular adsorption system(DPMAS),etc.)of non-biological artificial hepatic combined treatment that use the efficacy of half-or small-dose plasma,which to explore a new method for the treatment of hepatic failure of hepatic failure under the condition of blood source strain.MethodFrom January 2014 to May 2017,the Department of Infectious Diseases of the First Affiliated Hospital of Kunming Medical University have received non-biological artificial hepatic medicine treatment patients who suffered from acute,subacute or hepatic failure of chronic acute and subacute in the early and middle stage,which was clasified into full-dose plasma PE group(group A)and combination non-biological artificial liver groups(B,C,D).The combined non-biological artificial livers were divided into three groups based on different combinations:half-dose plasma PE + plasma perfusion(group B),600 mL plasma PE + plasma perfusion(group B1);half-dose plasma PE+ bilirubin adsorption(group C),600mL plasma PE+ bilirubin adsorption(Group Cl);half-dose plasma PE + DPMAS(Group D),600 mL plasma PE + DPMAS(Group D1).All the above cases was performed by artificial liver treatment on the basis of medical treatment.SPSS22.0 software was used for statistical analysis of the collected data which consists of the following parts:age,gender,causes of hepatic failure,clinical symptoms before and after artificial liver treatment,degree of changes in blood biochemical indicators(ALT?AST?TB?DB?ALB)or in blood coagulation function(PTA)before and after artificial liver treatment and short-time efficiency after treatment as well as other indicators.Result1.Changes exists in biochemical indexes of full-dose plasma PE(Group A)V.S half-dose plasma Groups(B,C,D).There was no significant difference in the biochemical indexes of the four groups of non-biological artificial liver before treatment.However the biochemical indexes,blood coagulation function as well as clinical symptoms were significantly improved before and after treatment,of which the differences were statistically significant(p<0.05).The improvement of ALT,DB,and PTA or ALB through the comparison of groups A,B,C,and D,respectively were the best efficacy of ?ALT,B and D groups,the best efficacy of ADB,D group as well as the best efficacy of ?PTA,?ALB,and A groups.2.Changes exists in biochemical indexes of small-dose plasma(B1 group,C1 group,D1 group).There was no significant difference in the biochemical indexes of the three groups of non-biological artificial liver before treatment.However the biochemical indexes,blood coagulation function as well as clinical symptoms were significantly improved before and after treatment,of which the differences were statistical significance(p<0.05).The improvement of ALT,DB,PTA and ALB through the comparison of groups B1,C1,D1 respectively were the best efficacy of AALT,B1,D1 group but absence of significant difference(40.3±21.5 vs 36.5±15.5,p>0.05),the best efficacy of ?DB,D1 group,the best efficacy ofAALB,C1 group as well as the best efficacy of ?PTA,D1 group.3.The comparison results between full-dose plasma PE group(group A)and half-dose plasma PE + plasma perfusion(group B)are as follows:the differences in?ALT between the two groups(50.1?±20.4 vs 73.4±26.3)was statistical significance(p<0.05);the differences in ATB(12.0±44.1 vs 33.5±130.3)was no statistical significance(p>0.05);the differences in ?DB(68.8±39.8 vs 69.4±44.5)was no statistical significance(p>0.05).Above results showed that the two treatments have comparable efficacy in improving TB and DB,while PE combined with PP have statistically significant differences in ALT improvement compared with full-scale PE.In addition,differences that posse of statistical significance(p<0.05)in AALB(7.2±3.2 vs 2.3±0.9)as well as differences that posse of statistical significance(p<0.05)in APTA%(19±12 vs 10±10)indicate that PE treatment is better at improving ALB and PTA.4.The comparison results between full-dose plasma PE group(group A)and half-dose plasma PE + bilirubin adsorption(group C)are as follows:the differences in?ALT between the two groups(50.1±20.4 vs 56.6±20.5)was statistical significance(p<0.05);the differences in ?TB(11.9±44.1 vs 103.9±44.2)was statistical significance(p<0.05);the differences in ?DB(68.8±39.8 vs 88.5±44.0)was statistical significance(p<0.05);the differences in ?ALB(7.2±3.2 vs 5.7±4.5)was no statistical significance(p>0.05);the differences in ?PTA%(19±12 vs 16±9)was no statistical significance(p>0.05).Above results indicated that the two treatments are similar efficacy in terms of improving ALB and PTA,but PE + PBA treatment are better in improving TB and DB;in terms of improving ALT,the full dose of PE is more effective.5.The comparison results between full-dose plasma PE group(group A)and half-dose plasma PE combined with DPMAS are as follows:the differences in ?ALT between the two groups(50.1±20.4 vs 150.1 ±433.6)was no statistical significance(p>0.05);the differences in ?TB(11.9±44.1 vs 128.1±83.0)was statistical significance(p<0.05);the differences in ADB(68.8±39.8 vs 90.8±57.5)was statistical significance(p<0.05);the differences in AALB(7.2±3.2 vs 2.5±3.6)was statistical significance(p<0.05);the differences in APTA%(19±12 vs 191±9)was no statistical significance(p>0.05).The results showed that the two treatment methods were equivalent in improving ALT and PT A,but PE and PBA treatment were better in improving TB and DB.In addition,the full-dose PE was better in improving ALB.6.PE combined with PP vs PE combined with PBA:? half-dosage group(B vs C group):?ALT was statistically significant(p<0.05);?TB(33.5±130.3 vs 103.9±44.2)was statistically significant(p<0.05)ADB(69.4±44.5 vs 88.5±44.0)was statistically significant(p<0.05);AALB(2.4±0.9 vs 5.8±4.5)was statistically significant(p<0.05);APTA%was(18± 13).Vs 22±9)The difference was statistically significant(p<0.05).? Small amount groups(B1 vs.C1):?ALT was statistically significant(p<0.05);ATB(71.0±49.1 vs 125.2±40.4)was statistically significant(p<0.05);ADB(72.6±45.9 vs 99.9±38.9)The difference was statistically significant(p<0.05);AALB(2.2±0.8 vs 5.6±7.1)was statistically significant(p<0.05);APTA%(10±10 vs 16±9)was statistically different.Significance(p<0.05).The results showed that PE combined with PP had a better effect in improving ALT;in the improvement of PTA,TB,DB,and ALB,PE combined with PBA had a better effect.7.Combination of PE and PP vs PE combined with DPMAS:1 half dose group(B vs.D group):There was no significant difference in ?ALT(p>0.05);ATB(33.5±130.3 vs 128.1±83.0)was statistically significant(p<0.05).ADB(69.4±44.5 vs 90.8±57.5)was statistically significant(p<0.05);AALB(2.4±0.9 vs 2.5±3.6)was not statistically significant(p>0.05);APTA%was(31±13).Vs 36±19)The difference was not statistically significant(p>0.05).2 Small amounts(B1 vs.D1):?ALT was not statistically significant(p>0.05);?TB(71.0±49.1 vs 131.2±65.7)was statistically significant(p<0.05);?DB(72.6±45.9 vs 114.0±55.9)The difference was statistically significant(p<0.05);AALB(2.2±0.8 vs 2.0±0.8)was not statistically significant(p>0.05);APTA%(10±10 vs 10±9)was not statistically different.Significance(p>0.05).The results showed that the two methods had similar therapeutic effects in terms of improving ALT,ALB,and PTA,and the combination of PE and DPMAS improved the treatment of TB and DB.8.PE combined with PBA vs PE combined with DPMAS:1 half-dose(C vs.D):?ALT was statistically significant(p<0.05);ATB(103.9±44.2 vs 128.1±83.0)was not statistically significant(p(>0.05);ADB(88.5±44.0 vs 90.8±57.5)showed no significant difference(p>0.05);?ALB(5.8±4.5 vs 2.5±3.6)showed statistically significant difference(p<0.05);?PTA%(22 ±9 vs 36±19)was statistically significant(p<0.05).2 Small amount groups(Cl vs.D1):?ALT(statistically significant difference(p<0.05);ATB(125.2±40.4 vs 131.2±65.7)showed no significant difference(p>0.05);?DB(99.9±38.9)There was no statistically significant difference(11.05±55.9 vs.114.0±55.9)(p>0.05);there was a statistically significant difference in ?ALB(5.6±7.1 vs 2.0±0.8)(p<0.05);and there was no difference in ?PTA%(16±9 vs 19±9).Statistical significance(p>0.05)indicates that the two methods have similar therapeutic effects in improving TB,DB,and PTA,and PE and DPMAS are more effective in improving ALT,and PE and PBA are more effective in improving ALB.ConclusionA small amount of plasma exchange combined with double plasma molecular adsorption system is an effective artificial liver treatment method for liver failure in the early and middle stages.Compared with PE combined with PP and PE combined with PBA,it can absorb the inflammatory factors and bilirubin of the patient while saving plasma.It is a safe and effective artificial liver treatment option. |
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