非生物型人工肝支持系统治疗原发性胆汁性胆管炎患者的临床疗效及预后影响

doi:10.3969/j.issn.1006-5725.2024.07.013

Abstract

Abstract:

Objective To evaluate the clinical efficacy of plasma exchange （PE） and double plasma molecular absorption system （DPMAS） in the treatment of primary biliary cholangitis （PBC） and the effect of this therapy on prognosis. Methods The clinical data on 526 PBC patients in our hospital from December 2013 to January 2022 were retrospectively analyzed. The patients were divided into different groups according to different therapies and then matched with propensity. The changes in symptoms， laboratory indexes and MELD scores were compared between two groups before and after treatment， and the clinical efficacy of artificial liver treatment for PBC patients was assessed. The effect of this treatment on the survival outcomes in these patients via comparing the cumulative survival rates at 3， 6 and 12 months between the two groups. Results The efficiency was better in the group with artificial liver treatment in addition medical therapy than the group with medical treatment alone， the difference was statistically significant （76.7% vs. 55.8%， χ² = 4.214， and P = 0.040）. Cox proportional risk regression showed that TBIL was an independent risk factor affecting the 3?， 6?， or 12?month survival in PBC patients. Conclusions Artificial liver support system can effectively relieve symptoms， reduce levels of ALT， AST and TBIL， improve blood coagulation function， and lower MELD scores in PBC patients. This therapy revealed a trend of improvement in 3?， 6?， or 12?month survival outcomes.

Key words: primary biliary cholangitis, artificial liver, curative effect, prognosis

CLC Number:

R575.2

Futao DANG,Yingmei TANG,Haiyan FU,Huanlong LI,Jiamin XU,Xu. TAN. The efficacy of artificial （nonbiological） extracorporeal liver support system for primary biliary cholangitis and the effect of this therapy on prognosis[J]. The Journal of Practical Medicine, 2024, 40(7): 955-961.

Figures/Tables 9

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References 23

1	HIRSCHFIELD G M ， DYSON J K ， ALEXANDER G J M ， et al .The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines ［J］.Gut， 2018， 67（9）：1568-1594. doi:10.1136/gutjnl-2017-315259 doi: 10.1136/gutjnl-2017-315259
2	YANG L ， WU T ， LI J ， et al . Chinese Group on the Study of Severe Hepatitis B. Artificial liver treatment improves survival in patients with hepatitis B virus-related acute-on-chronic liver failure： A case-control matched analysis［J］. Hepatol Res， 2020， 50（6）：656-670. doi:10.1111/hepr.13497 doi: 10.1111/hepr.13497
3	REBAHI H ， STILL M E ， ADIB A R EL . A successful use of therapeutic plasma exchange in a fulminant form of acute fatty liver of pregnancy［J］. Gynecol Obstet Hum Reprod， 2019， 48（2）：133-137. doi:10.1016/j.jogoh.2018.10.001 doi: 10.1016/j.jogoh.2018.10.001
4	LIU C T ， CHEN T H ， CHENG C Y . Successful treatment of drug-induced acute liver failure with high-volume plasma exchange［J］. Clin Apher， 2013， 28（6）：430-434. doi:10.1002/jca.21291 doi: 10.1002/jca.21291
5	TURNBERG L A ， MAHONEY M P ， GLEESON M H ， et al . Plasmaphoresis and plasma exchange in the treatment of hyperlipaemia and xanthomatous neuropathy in patients with primary biliary cirrhosis［J］. GUT， 1972，13（12）： 976-981. doi:10.1136/gut.13.12.976 doi: 10.1136/gut.13.12.976
6	COHEN L B ， AMBINDER E P ， WOLKE A M ， et al . Role of plasmapheresis in primary biliary cirrhosis［J］. GUT， 1985，26 （3）： 291-294. doi:10.1136/gut.26.3.291 doi: 10.1136/gut.26.3.291
7	周明，应美爱，潘健，等 . 血浆置换治疗原发性胆汁性肝硬化1例［J］. 临床输血与检验， 2015，17（2）：176-177. doi:10.3969/j.issn.1671-2587.2015.02.031 doi: 10.3969/j.issn.1671-2587.2015.02.031
8	李亚峰，王树亚，李平 . 血浆置换治疗失代偿期原发性胆汁性肝硬化1例［J］. 江苏医药， 2018，44（4）：477-478.
9	MULLHAUPT B ， KULLAK-UBLICK G A ， AMBÜHL P M ， et al . Successful use of the Molecular Adsorbent Recirculating System （MARS） in a patient with primary biliary cirrhosis （PBC） and treatment refractory pruritus［J］. Hepatol Res， 2003，25 （4）： 442-446. doi:10.1016/s1386-6346(02)00310-8 doi: 10.1016/s1386-6346(02)00310-8
10	PARÉS A ， HERRERA M ， AVILÉS J ， et al . Treatment of resistant pruritus from cholestasis with albumin dialysis： combined analysis of patients from three centers［J］. J Hepatol， 2010，53 （2）： 307-312. doi:10.1016/j.jhep.2010.02.031 doi: 10.1016/j.jhep.2010.02.031
11	LINDOR K D ， BOWLUS C L ， BOYER J ， et al . Primary Biliary Cholangitis： 2018 Practice Guidance from the American Association for the Study of Liver Diseases［J］. Hepatology， 2019，69（1）：394-419. doi:10.1002/hep.30145 doi: 10.1002/hep.30145
12	European Association for the study of the liver . EASL Clinical Practice Guidelines： The diagnosis and management of patients with primary biliary chol angitis［J］. J Hepatol， 2017，67（1）：145-172. doi:10.1016/j.jhep.2017.03.022 doi: 10.1016/j.jhep.2017.03.022
13	中华医学会感染病学分会肝衰竭与人工肝学组 . 非生物型人工肝治疗肝衰竭指南（2016 年版）［J］. 中华临床感染病杂志，2016，9（2）：97-103.
14	JANMOHAMED A ， TRIVEDI P J . Patterns of disease progression and incidence of complications in primary biliary cholangitis （PBC）［J］. Best Pract Res Clin Gastroenterol， 2018，34（35）：71-83.
15	RNOLFSSON K T ， LUND S H ， OLAFSSON S ， et al . Biochemical response to ursodeoxycholic acid among PBC patients： a nationwide population-based study［J］. Scand J Gastroenterol，2019， 54（5）：609-616. doi:10.1080/00365521.2019.1606931 doi: 10.1080/00365521.2019.1606931
16	ICHIKAWA T ， SATO H ， KAIRA K ， et al . Prolonged intrahepatic cholestasis after exposure to loxoprofen［J］. Clin Ther，2008， 30（12）： 2402-2406. doi:10.1016/j.clinthera.2008.12.012 doi: 10.1016/j.clinthera.2008.12.012
17	PUSL T ， DENK G U ， PARHOFER K G ， et al . Plasma separation and anion adsorption transiently relieve intractable pruritus in primary biliary cirrhosis［J］. J Hepatol， 2006，45（6）：887-891. doi:10.1016/j.jhep.2006.08.008 doi: 10.1016/j.jhep.2006.08.008
18	WUNSCH E ， KRUK B ， SNARSKI E ， et al . Plasmapheresis in the treatment of chronic fatigue in patients with primary biliary cholangitis［J］. Pol Arch Intern Med， 2021，131（2）：205-207.
19	CHEN J J ， HUANG J R ， YANG Q ， et al .Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-on-chroni c liver failure： a nationwide prospective multicenter study in China［J］. Hepatobiliary Pancreat Dis Int， 2016， 15（3）：275-281. doi:10.1016/s1499-3872(16)60084-x doi: 10.1016/s1499-3872(16)60084-x
20	GUO X ， WU F ， GUO W ，et al . Comparison of plasma exchange， double plasma molecular adsorption system， and their combination in treating acute-on-chronic liver failure［J］. J Int Med Res，2020， 48（6）：300060520932053. doi:10.1177/0300060520932053 doi: 10.1177/0300060520932053
21	MAO W ， YE B ， LIN S ， et al . Prediction value of model for end-stage liver disease scoring system on prognosis in the acute on chr onic liver failure patients with plasma exchange treatment［J］.Asaio J， 2010， 56（5）：475-478. doi:10.1097/mat.0b013e3181e6bf13 doi: 10.1097/mat.0b013e3181e6bf13
22	SHEN Y ， WANG X L ， WANG B ， et al . Survival Benefits With Artificial Liver Support System for Acute-on-Chronic Liver Failure： A Time Ser ies-Based Meta-Analysis［J］. Medicine （Baltimore）， 2016， 95（3）：e2506. doi:10.1097/md.0000000000002506 doi: 10.1097/md.0000000000002506
23	党富涛，唐映梅，谭绪，等 . 原发性胆汁性胆管炎患者中人工肝支持系统的应用［J］. 实用医学杂志， 2020，36（22）：3153-3156. doi:10.3969/j.issn.1006-5725.2020.22.025 doi: 10.3969/j.issn.1006-5725.2020.22.025

	对照组			观察组			χ²值	P值
	治疗前	治疗后	好转率（%）	治疗前	治疗后	好转率（%）	χ²值	P值
疲劳	38	12	68.4	36	11	69.4	0.009	0.924
瘙痒	9	4	55.6	11	4	63.6	0.135	0.714
腹痛	11	5	54.5	14	5	64.3	0.244	0.622
腹胀	29	11	62.1	25	8	68.0	0.207	0.649
纳差	30	9	70.0	31	8	74.2	0.133	0.715
黄疸	33	15	54.5	39	14	64.1	0.679	0.410

分组	累计生存率（%）
分组	3个月	6个月	12个月
对照组	70.2	52.7	34.6
观察组	82.4	70.9	53.4
χ²值	2.225	0.582	2.801
P值	0.136	0.446	0.094

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The efficacy of artificial （nonbiological） extracorporeal liver support system for primary biliary cholangitis and the effect of this therapy on prognosis

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