摘要
目的比较单独血浆置换(plasma exchange,PE)和联合双重血浆吸附(double plasma molecular absorb system,DPMAS)人工肝治疗模式对慢性肝病患者纤维蛋白原的影响。方法选择2020年月—2022年5月于遵义医科大学附属医院就诊的58例终末期肝病患者为研究对象,其中29例患者接受PE治疗,29例患者接受PE+DPMAS治疗,比较两组患者治疗前后凝血功能(特别是纤维蛋白原)、肝功能指标的变化情况,治疗期间不良反应发生率。结果PE组和PE+DPMAS组治疗前后纤维蛋白原、总胆红素、淋巴细胞绝对值、前白蛋白、ALT、AST、FAR、FPR比较,差异均具有统计学意义(P<0.05),且PE+DPMAS组患者纤维蛋白原的下降更为显著(1.76±0.62 vs 1.41±0.40,t=3.788,P<0.001)。PE+DPMAS组患者治疗后血小板水平显著低于治疗前(111.72±42.96 vs 93.69±48.33,t=2.753,P<0.05),但PE组患者治疗后血小板水平变化差异无统计学意义(95.97±47.73 vs 88.72±59.70,t=0.753,P>0.05),两组治疗前后白蛋白比较差异无统计学意义(P>0.05)。两组治疗过程中瘙痒(10.3%vs 10.3%)、皮疹(10.3%vs 3.4%)、血压、心率下降(3.4%vs 0.0%)、寒战、腹胀、呼吸困难发生率(0.0%vs 6.9%)比较,差异均无统计学意义(P>0.05)。结论与PE模式相比,PE+DPMAS人工肝模式对纤维蛋白原的损耗较大,且血小板降低更为显著,患者出血风险较PE治疗模式更高。
Objective To investigate the effect of plasma exchange(PE)and double plasma molecular adsorbent system(DPMAS)on fibrinogen in patients with chronic liver disease.Methods A totl of 58 patients with end-stage liver disease admitted to our hospital from January 2020 to may 2022 were selected as the research objects,among which 29 patients received PE treatment and 29 patients received PE+DPMAS treatment.Compare the changes of coagulation function(especially fibrinogen)and liver function indexes before and after treatment between the 2 groups,and the incidence of adverse reactions during treatment.Results The differences of fibrinogen,total bilirubin,absolute lymphocyte values,prealbumin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),fractional albuminuria rate(FAR),and formyl peptide receptor(FPR)before and after treatment were statistically significant(P<0.05)before and after treatment in 2 groups,and the decrease in fibrinogen was more significant(1.76±0.62 vs 1.41±0.40,t=3.788,P<0.001)in the PE+DPMAS.Platelet levels in the PE+DPMAS group were significantly lower than those in the PE+DPMAS group(111.72±42.96 vs 93.69±48.33,t=2.753,P<0.05),but there was no statistically significant difference in platelet level changes after treatment in the PE group(95.97±47.73 vs 88.72±59.70,t=0.753,P>0.05),and there was no statistically significant difference in albumin before and after treatment between the 2 groups(P>0.05).There was no significant difference in the incidence of pruritus(10.3%vs 10.3%),rash(10.3%vs 3.4%),blood pressure,decreased heart rate(3.4%vs 0.0%),chills,bloating,and dyspnea(0.0%vs 6.9%)between the 2 groups during treatment(P>0.05).Conclusion Compared with PE model,PE+DPMAS artificial liver model has greater loss of fibrinogen,more significant reduction of platelet,and higher bleeding risk than PE model.
作者
代梅
申友书
赵菲
肖乐尧
杨平
罗亚文
DAI Mei;SHEN You-shu;ZHAO Fei;XIAO Le-yao;YANG Ping;LUO Ya-wen(School of Nursing,Zunyi Medical University,Guizhou 563000,China;Department of Infection,Affiliated Hospital of Zunyi Medical University,Guizhou 563000,China)
出处
《肝脏》
2023年第5期523-526,共4页
Chinese Hepatology
基金
贵州省科学技术厅基金资助项目(黔科合支撑[2021]一般049)。
