Effect Of Plasma Exchange On Different Degrees Of HBV-related Liver Failure

Objective : To observe and analyze the therapeutic effect of plasma exchange for patients with different degrees of HBV-related liver failure and explore the optimal intervention opportunity.Methods:We collected 397 patients with HBV-related liver failure who were hospitalized on October 1,2013 to October 1,2018.The patients were divided into the plasma exchange group(n=147)and the control group(n=250)according to whether they received plasma exchange therapy.Each group was further divided into four subgroups according to i MELD score: i MELD < 35(group A1 and group B1),35?i MELD<45(group A2 and group B2),45?i MELD<55(group A3 and group B3),and i MELD?55(group A4 and group B4).The improvement of clinical symptoms,changes of clinic biomedical indicators and i MELD score in each subgroup before and after treatment were observed.The short-term mortality at 1 month and 3 months in each subgroup were compared.Kaplan-meier survival curves were drawn for each subgroup to analyze and compare the effects of plasma exchange on short-term mortality and survival time at 3 months.The efficacy of single and multiple plasmapheresis was compared.Results : The total improvement rate of clinical symptoms of plasma exchange combined with medical treatment was significantly higher than that of the control group.There were statistically significant differences in clinical symptom improvement rates between A2 and B2,A3 and B3(P>0.05).After plasma exchange combined with medical treatment,TBil,INR,AST,ALT,serum ammonia,ALB,PTA,PWR and HBV-DNA were significantly improved in patients with i MELD < 35,TBil,INR,AST,ALT,serum ammonia,PTA,PWR and HBV-DNA were significantly improved in patients with 35?i MELD< 45,TBil,AST,ALT,PWR and HBV-DNA were significantly improved in patients with 45?i MELD<55,only ALT were reduced in Patients with i MELD> 55.Patients with i MELD < 45 had significantly lower i MELD scores after treatment than before(P<0.05).Patients in the plasma exchange group with 35?i MELD<45 had significantly lower i MELD score than the control group,and the difference was statistically significant(P<0.05).Patients were followed up for 3 months after treatment,comparison of each subgroup showed that patients in the plasma exchange group with 35?i MELD<45 could effectively reduce mortality and prolong survival time compared with the control group at 1 month and 3 months.The difference of mortality and survival curve was statistically significant(P<0.05).Compared with single plasma exchange,multiple plasma exchange can significantly reduce the clinical symptoms and the mortality at 1month for patients with 35 ? i MELD < 55,as well as the i MELD score of patients with i MELD?45,however,it had no effect on mortality and survival time at 3 months.Conclusion : 1.The effect of plasma exchange combined with medical treatment was as well as that of medical treatment alone for patients whose i MELD score were less than 35;2.The effect of plasma exchange combined with medical treatment was better than that of medical treatment alone for patients whose i MELD score were 35-45,which can significantly reduce i MELD score,reduce short-term mortality for 1 month and 3 months and prolong survival time for 3 months;3.The effects of plasma exchange and medical treatment were not satisfactory for Patients whose i MELD score higher than 45;4.Multiple plasma exchange can reduce the mortality at 1 month in patients with 35?i MELD<55compared to the single plasma exchange.