Double Plasma Molecular Adsorption System with Sequential Low-dose Plasma Exchange in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure:A Prospective Study

作     者：Lu Wang Wenxiong Xu Shu Zhu Guoli Lin Jing Lai Yufeng Zhang Ying Liu Lihua Zheng Qiumin Luo Zhiliang Gao Chan Xie Liang Peng 

作者机构：Second School of Clinical MedicineBinzhou Medical UniversityYantaiShandongChina Department of Infectious DiseasesThird Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouGuangdongChina Key Laboratory of Tropical Disease Control(Sun Yat-sen University)Ministry of EducationGuangzhouGuangdongChina 

出 版 物：《Journal of Clinical and Translational Hepatology》 (临床与转化肝病杂志（英文版）)

年 卷 期：2023年第11卷第4期

页      面：908-917页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：This study was supported by grants from the National major science and technology project for the prevention and treatment of AIDS and viral hepatitis(2018ZX10302204-002-002 to LP,2018ZX10302205-002 to CX) Natural Science Foundation of China(No.81873572 to LP,82070611 to LP) Guangzhou Science and Technology Plan Projects(201904010442 to CX,202102010204 to LP) Guangdong Science and Technology Plan Projects(2020A1515010317 to CX) Sun Yat-Sen University Clinical Research 5010 Program(2018009 to CX,2020007 to LP) the Five-Year Plan of Third Affiliated Hospital of Sun Yat-Sen University(K00006 to LP) 

主　　题：Plasma exchange Double plasma molecular adsorption system Acute-on-chronic liver failure Prognosis 

摘      要：Background and Aims:To investigate the safety and efficacy of double plasma molecular adsorption system(DPMAS)with sequential low-dose plasma exchange(LPE)in treating early hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods:Clinical data of patients with HBVACLF were prospectively collected,including patients in a DPMAS with sequential LPE(DPMAS+LPE)group and those in a standard medical treatment(SMT)*** primary endpoint was death or liver transplantation(LT)at 12 weeks of ***-score matching was performed to control the effects of confounding factors on prognosis between the two ***:After 2 weeks,total bilirubin,alanine aminotransferase,blood urea nitrogen levels,and Chinese Group on the Study of Severe Hepatitis B score,were significantly lower in the DPMAS+LPE group than those in the SMT group(p0.05).After 4 weeks,laboratory parameters of the two groups were *** cumulative survival rate of the DPMAS+LPE group was significantly higher than that of the SMT group at 4 weeks(97.9%vs.85.4%,p=0.027),but not at 12 weeks(85.4%vs.83.3%,p=0.687).Cytokine levels were significantly lower in 12-week survival group than in the death-or-LT group(p0.05).Functional enrichment analysis showed that downregulated cytokines were mainly involved in positive regulation of proliferation and activation of lymphocytes and monocytes,regulation of immune effect response,regulation of endotoxin response,and glial cell ***:DPMAS+LPE significantly improved the 4-week cumulative survival rate,and ameliorated the inflammatory response in ***+LPE may be a promising modality for patients with early HBV-ACLF.