【摘要】 目的 研究双重血浆分子吸附系统(DPMAS)联合血浆置换(PE)治疗肝衰竭的效果。方法 纳入广东省人民医院2018年10月至2022年5月收治的138例肝衰竭患者，根据随机、对照、双盲原则，以随机数字表法将患者分为A、B、C 3组，每组46例。A组行DPMAS治疗，B组行PE治疗，C组行DPMAS序贯PE治疗。记录3组治疗效果。检测3组患者肝功能指标(AST、ALT、TBil)、血清细胞因子(TNF-α、IFN-γ及IL-6)及凝血功能指标(PT、INR、PTA)水平变化情况。结果 治疗第90天时C组显效22例，有效14例，无效3例，死亡7例；显著优于A组(显效12例，有效19例，无效3例，死亡12例)和B组(显效11例，有效18例，无效3例，死亡14例)(Z=-2.044、-2.408,P=0.041、0.016)。B组治疗第28天、第90天时TBil为(201.1±77.4)μmol/L和(93.6±28.2)μmol/L,显著高于A组的(157.9±56.2)μmol/L和(80.2±21.7)μmol/L和C组的(162.7±50.2)μmol/L和(78.6±24.6)μmol/L(F=6.630、5.004,P=0.002、0.008)。C组治疗第90天时血清TNF-α、IFN-γ及IL-6分别为(20.6±14.4)pg/mL、(32.4±13.8)pg/mL及(31.7±10.1)ng/L,显著低于A组的(34.2±16.2)pg/mL、(43.2±18.4)pg/mL及(48.7±14.4)ng/L和B组的(35.7±17.3)pg/mL、(40.6±17.6)pg/mL及(50.0±12.8)ng/L(F=12.417、5.228、30.406,P<0.01、0.007、<0.01)。治疗第90天时A组PT和INR分别为(18.3±3.8)s和(1.23±0.11),显著高于B组的(15.1±3.6)s和(1.10±0.09)、C组的(14.6±3.9)s和(1.07±0.27),(F=13.052、10.722,均P<0.01)。结论 DPMAS序贯PE治疗方案用于肝衰竭患者，能发挥DPMAS和PE各自优势，清除细胞因子，改善凝血紊乱状态，保护肝功能，提高疗效。更多还原

【Abstract】 Objective To study the curative effect of double plasma molecular adsorption system(DPMAS) combined with plasma exchange(PE) on patients with liver failure. Methods A total of 138 patients with liver failure from October 2018 to May 2022 were enrolled. The patients were randomly divided into DPMAS group(Group A), PE group(Group B) and DPMAS+ PEgroup(Group C) with 46 cases in each group. The changes of liver function indexes(AST, ALT, TBil), the serum cytokines(TNF-α, IFN-γ and IL-6) and coagulation function(PT, INR, PTA) in the 3 groups were collected. Results On the 90th day of treatment, managment in Group C was assessed as markedly effective in 22 cases, effective in 14 cases and ineffective in 3 cases. 7 cases died during the treatment. The intervention outcomes for Group C outperformed those of both Group A(which had 12 effective cases, 19 effective cases, 3 ineffective cases and 12 deaths) and Group B(which had 11 effective cases, 18 effective cases, 3 ineffective cases, 14 deaths)(Z=-2.044,-2.408; P=0.041, 0.016). On the 28th and 90th of treatment, the levels of TBil in Group B[(201.1±77.4) μmol/L and(93.6±28.2) μmol/L, respectively] were significantly higher than those in Group A [(157.9±56.2) μmol/L and(80.2±21.7) μmol/L] and Group C [(162.7±50.2) μmol/L and(78.6±24.6) μmol/L, F=6.630、5.004,P=0.002、0.008]. On the 90th day of treatment, the serum levels of TNF-α, IFN-γ and IL-6 in Group C[(20.6±14.4) pg/mL,(32.4±13.8) pg/mL and(31.7±10.1) ng/L, respectively] were significantly lower than those in group A [(34.2±16.2) pg/mL,(43.2±18.4) pg/mL and(48.7±14.4) ng/L] and group B [(35.7±17.3) pg/mL,(40.6±17.6) pg/mL and(50.0±12.8) ng/L]. F=12.417、5.228、30.406,all P<0.05]. On the 90th day of treatment, PT and INR in Group A[(18.3±3.8) s and(1.23±0.11), respectively] were significantly higher than those in Group B [(15.1±3.6) s and(1.10±0.09)] and Group C [(14.6±3.9) s and(1.07±0.27), F=13.052、10.722,P=0.000、0.000]. Conclusion The DPMAS sequential PE therapy for patients with liver failure effectively leverages the strengths of both DPMAS and PE. It is capable of clearing cytokines, improving coagulation disorder, safeguarding liver function and thereby enhancning the overal therapeutic efficacy.更多还原