经选择性血浆分离器行人工肝治疗低血小板计数慢加急性肝衰竭患者的效果及安全性分析

李守娟; 王丽; 周明; 吴蓓; 王磊; 段萌; 廖洪帆; 胡瑞晴; 胡朝霞; 朱丽; 胡娟

doi:10.12449/JCH240619

经选择性血浆分离器行人工肝治疗低血小板计数慢加急性肝衰竭患者的效果及安全性分析

DOI: 10.12449/JCH240619

李守娟^1, , ,,
王丽¹,
周明²,
吴蓓¹,
王磊¹,
段萌¹,
廖洪帆¹,
胡瑞晴¹,
胡朝霞¹,
朱丽¹,
胡娟²

a.
成都市公共卫生临床医疗中心肝病科，成都 610066
b.
成都市公共卫生临床医疗中心人工肝治疗中心，成都 610066

基金项目:

成都市卫生健康委员会 (2021435);

中国公共卫生联盟课题（第一批） (GWLM202037)

伦理学声明： 本研究方案分别于2020年11月23日、2021年9月13日经由成都市公共卫生临床医疗中心医学伦理委员会审批，批号分别为：PJ-K2020-58-01、PJ-K2021-38-01，所有治疗和检测均获得患者或家属知情同意，均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李守娟负责设计论文框架，拟定写作思路，负责数据收集，统计学分析，绘制图表，起草论文；周明、吴蓓、王磊、段萌、廖洪帆、胡瑞晴、胡朝霞、朱丽、胡娟负责病例选择和临床资料整理；王丽负责文章的审阅和修改。

详细信息

通信作者:
李守娟， lishoujuan2005@126.com （ORCID： 0009-0000-6382-0346）

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出版历程
- 收稿日期: 2023-08-07
- 录用日期: 2023-11-06
- 出版日期: 2024-06-25

Efficacy and safety of artificial liver support therapy with a selective plasma separator in low-platelet count patients with acute-on-chronic liver failure

a.
Department of Hepatology,Chengdu Public Health Medical Center，Chengdu 610066，China
b.
Center for Artificial Liver Support Therapy，Chengdu Public Health Medical Center，Chengdu 610066，China

Research funding:

Health Commission of Chengdu Municipality (2021435);

Chinese Public Health Alliance Project （first batch） (GWLM202037)

More Information

Corresponding author: LI Shoujuan， lishoujuan2005@126.com （ORCID： 0009⁃0000⁃6382⁃0346）

摘要

摘要: 目的对不同分层血小板计数的慢加急性肝衰竭（ACLF）患者采用Evacure-4A膜型选择性血浆分离器行人工肝治疗，观察其疗效、安全性及对血小板的影响。方法选取2021年1月—2023年5月于成都市公共卫生临床医疗中心肝病科住院的302例低血小板计数ACLF患者，根据血小板计数将其分为3组：A组（血小板计数：25×10⁹/L～50×10⁹/L）101例；B组（血小板计数：51×10⁹/L～80×10⁹/L）98例；C组（血小板计数：81×10⁹/L～100×10⁹/L）103例。所有患者在内科治疗的基础上根据病情给予不同模式人工肝治疗：包括血浆灌流联合血浆置换、双重血浆分子吸附联合血浆置换、胆红素吸附联合血浆置换。计量资料各组治疗前后比较采用配对t检验，多组间比较采用方差分析，进一步两两比较采用SNK-q检验。计数资料多组间比较采用χ²检验。结果 88.74%（268/302）患者人工肝治疗后临床症状呈不同程度改善。治疗后各组患者肝功能ALT（t值分别为14.755、21.614、15.965）、AST（t值分别为11.491、19.301、3.919）、TBil（t值分别为19.182、17.486、21.75）较治疗前均呈不同程度下降（P值均<0.001）；INR呈不同程度缩短（t值分别为3.497、3.327、4.358，P值均<0.05）。使用Evacure-4A膜型选择性血浆分离器行人工肝治疗后，A、B、C组血小板计数分别由治疗前（37.73±6.27）×10⁹/L、（66.97±7.64）×10⁹/L、（93.82±5.38）×10⁹/L降至治疗后（36.59±7.96）×10⁹/L、（62.59±7.37）×10⁹/L、（85.99±12.49）×10⁹/L，其中B、C组治疗前后比较均有统计学差异（t值分别为12.993、8.240，P值均<0.001），A组治疗前后比较无统计学差异（P>0.05）。3组间人工肝治疗中不良反应的发生率差异无统计学意义（P>0.05）。结论人工肝治疗能改善ACLF患者的肝功能及INR，使用Evacure-4A膜型选择性血浆分离器在人工肝治疗过程中对血小板的影响较小，治疗血小板明显低下ACLF患者是安全的。
- 慢加急性肝功能衰竭 /
- 肝，人工 /
- 血小板计数
Abstract: Objective To investigate the efficacy and safety of artificial liver support therapy with an Evanure-4A selective membrane plasma separator and its influence on platelet count in the treatment of patients with acute-on-chronic liver failure （ACLF） patients with different platelet counts. Methods A total of 302 patients with ACLF who were hospitalized in Department of Hepatology， Chengdu Public Health Clinical Medical Center， from January 2021 to May 2023， were enrolled， and according to the platelet count （PLT）， they were divided into group A （25×10⁹/L — 50×10⁹/L） with 101 patients， group B （51×10⁹/L — 80×10⁹/L） with 98 patients， and group C （81×10⁹/L — 100×10⁹/L） with 103 patients. In addition to medical treatment， all patients received different modes of artificial liver support therapy based on their conditions， including plasma perfusion combined with plasma exchange， double plasma molecular adsorption combined with plasma exchange， and bilirubin system adsorption combined with plasma exchange. The paired t-test was used for comparison of continuous data before and after treatment in each group； an analysis of variance was used for comparison between multiple groups， and the SNK-q test was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups. Results Of all 302 patients， 268 （88.74%） achieved varying degrees of improvement in clinical symptoms after artificial liver support therapy. After treatment， all three groups had varying degrees of reductions in alanine aminotransferase （t=14.755， 21.614， and 15.965， all P<0.001）， aspartate aminotransferase （t=11.491， 19.301， and 13.919， all P<0.001）， total bilirubin （t=19.182， 17.486， and 21.75， all P<0.001）， and international normalized ratio （INR）（t=3.497， 3.327， and 4.358， all P<0.05）. After artificial liver support therapy with an Evanure-4A selective membrane plasma separator， PLT in group A decreased from （37.73±6.27）×10⁹/L before treatment to （36.59±7.96）×10⁹/L after treatment， PLT in group B decreased from （66.97±7.64）×10⁹/L before treatment to （62.59±7.37）×10⁹/L after treatment， and PLT in group C decreased from （93.82±5.38）×10⁹/L before treatment to （85.99±12.49）×10⁹/L after treatment； groups B and C had significant reductions in PLT after treatment （t=12.993 and 8.240， both P<0.001）， but there was no significant difference in group A （P>0.05）. There was no significant difference in the incidence rate of adverse reactions during artificial liver support therapy between the three groups （P>0.05）. Conclusion Artificial liver support therapy can improve liver function and INR in patients with ACLF. The use of Evaure-4A selective membrane plasma separator during artificial liver support therapy has little influence on platelets， and it is safe in the treatment of ACLF patients with a significantly lower level of platelets.
- Acute-On-Chronic Liver Failure /
- Liver， Artificial /
- Platelet Count

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表 1 血小板计数不同分层ACLF患者的一般资料比较

Table 1. Comparison of general data of ACLF patients with different levels of platelet count

组别	例数	男/女（例）	年龄（岁）	INR	Alb（g/L）
A组	101	82/19	51.75±11.38	2.11±0.71	27.79±3.76
B组	98	75/23	51.53±10.96	1.98±0.46	28.79±3.61
C组	103	81/22	50.72±12.49	2.11±0.77	28.97±3.59
统计值		χ ²=0.649	F=0.223	F=1.221	F=3.058
P值		0.723	0.804	0.361	0.060

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表 2 血小板计数不同分层ACLF患者人工肝治疗前后肝功能、凝血、血小板变化

Table 2. Changes of liver function， blood coagulation and platelet count in patients with ACLF before and after artificial liver treatment

分组	例数	ALT（U/L）	AST（U/L）	Alb（g/L）	TBil（μmol/L）	INR	血小板计数（×10⁹/L）
A组	101
治疗前		1.97±0.34	2.05±0.33	27.79±3.76	322.30±149.56	2.11±0.71	37.73±6.27
治疗后		1.78±0.28	1.88±0.31	25.71±2.79	197.25±103.20	1.91±0.66	36.59±7.96
t值		14.755	11.491	9.650	19.182	3.497	1.820
P值		<0.001	<0.001	<0.001	<0.001	0.001	0.072
B组	98
治疗前		2.06±0.43	2.09±0.37	28.79±3.61	262.28±113.56	1.98±0.46	66.97±7.64
治疗后		1.87±0.38	1.90±0.32	25.78±3.89	159.23±78.79	1.86±0.56	62.59±7.37
t值		21.614	19.301	7.878	17.486	3.327	12.993
P值		<0.001	<0.001	<0.001	<0.001	0.001	<0.001
C组	103
治疗前		2.37±0.50	2.31±0.44	28.97±3.59	311.16±128.73	2.11±0.77	93.82±5.38
治疗后		2.11±0.44	2.07±0.36	26.26±3.27	183.96±96.01	1.89±0.80	85.99±12.49
t值		15.965	13.919	8.045	21.750	4.358	8.240
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

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