| Objective:To explore the efficacy of half-dose plasma exchange combined with dual plasma molecular adsorption system and glucocorticoid（Glucocorticoids,GCs）in the treatment of patients with liver failure and the analysis of the effects of different causes on the efficacy.Methods:A total of 128 patients with liver failure hospitalized in the second Hospital of Jilin University from October 2016 to February 2022 were divided into artificial liver treatment group（half dose PE+DPMAS）（57 cases）,hormone treatment group（30cases）and routine treatment group（41 cases）.According to the severity of clinical manifestations,they were divided into early stage group（n=77）,middle stage group（n=44）and late stage group（n=7）.Statistics of all patients’general data,ALT,ALB,TBIL,DBIL,PT,INR,PTA,PLT,adverse reactions in treatment and so on.The changes of indexes before and after treatment were compared in artificial liver treatment group,hormone treatment group and routine treatment group,and among artificial liver treatment group,hormone treatment group,early group and middle group.The changes of indexes before and after treatment were compared in early group,middle group,artificial liver treatment group and hormone treatment group.The effects of different etiology and different treatment methods on the efficacy of liver failure;adverse reactions and complications in artificial liver treatment group and hormone treatment group;all data were analyzed by SPSS26.0 software.Results:1.The effect of the treatment of liver failure on the curative effect:the effective rate was 80.7%in the artificial liver treatment group,70%in the hormone treatment group and 48.8%in the conventional treatment group.The difference between the groups was statistically significant（c~2=11.235,P=0.004<0.05）.2.In artificial liver treatment group,ALT,TBIL,DBIL,PT,INR,PLT decreased and ALB,PTA increased after treatment,the difference was statistically significant（P<0.05）;In hormone treatment group,ALT,TBIL,DBIL,PT and INR decreased,while ALB and PTA increased after treatment,the difference was statistically significant（P<0.05）,but there was no significant difference in PLT（P>0.05）;In the routine treatment group,ALT,TBIL,DBIL,PLT decreased and ALB increased after treatment,the difference was statistically significant（P<0.05）,but there was no significant difference in PT,INR and PTA（P>0.05）.3.Comparison of the difference between artificial liver treatment group,hormone treatment group and routine treatment group before and after treatment:after treatment,there was no significant difference in ALT and ALB among the three groups（P>0.05）,but there were significant differences in TBIL,DBIL,PT,INR,PTA and PLT（P<0.05）.4.Within the artificial liver treatment group,the early group and the middle group before and after treatment:in the artificial liver treatment group,the levels of TBIL,PT and INR in the middle group were significantly higher than those in the early group,and the difference was statistically significant（P<0.05）,but there was no significant difference in ALT,DBIL,ALB,PTA and PLT（P>0.05）.Within the hormone treatment group,there was no statistically significant difference in each index between the early group and the intermediate group before and after treatment（P>0.05）.5.In the early group,the comparison between artificial liver treatment group and hormone treatment group before and after treatment:INR and PTA in artificial liver treatment group were significantly lower than those in hormone treatment group,and the difference was statistically significant（P<0.05）,but there was no significant difference in ALT,ALB,TBIL,DBIL and PT（P>0.05）.In the middle group,the TBIL,DBIL,PT,INR and PLT in the artificial liver treatment group were higher than those in the hormone treatment group,while PTA was lower than that in the hormone treatment group,and the difference was statistically significant（P<0.05）.There was no significant difference in ALT and ALB（P>0.05）.6.The influence of the etiology of liver failure on the curative effect:the effective rate of liver failure is 47.1%because of hepatitis B,63.0%because of alcohol,97.2%of pathogenic drugs,75.0%of autoimmune liver and 100%of unknown etiology.there were significant differences among different etiological groups（c~2=28.993,P<0.05）.Conclusion:1.Artificial liver therapy,hormone therapy and routine therapy are all effective for patients with liver failure,and the curative effect of artificial liver therapy is better than that of hormone therapy and routine therapy.2.The therapeutic effect of patients with early liver failure is better than that of patients in the middle stage.Under different treatment methods,the improvement of artificial liver therapy is more significant for the patients in the middle stage.3.Among the patients with different causes of liver failure,the curative effect of drug-induced liver failure is the best,followed by autoimmune liver failure,alcoholic liver failure and hepatitis B liver failure. |
PDF Full Text Request