Analysis Of Influencing Factors Of Plasma Exchange In The Treatment Of Severe Jaundice Caused By Liver Disease

Objectives:this research is designed to observe the clinical characteristics of patients with severe jaundice caused by liver disease, and analyze influencing Factors of plasma exchange in the treatment of severe jaundice caused by liver disease.Methods:1.We retrospective review patients of severe jaundice due to liver disease with plasma exchange in the Department of Hepatobiliary and Pancreatic medicine of the Second Affiliated Hospital of Kunming Medical University from January 2014 to January 2016, datum of 138 patients are complete, and all are based on the treatment of standard medical treatment with plasma exchange.2. We collect easily available clinical 29 factors that may affect the efficacy of plasma exchange, including gender, age, nosetiology type, times of plasma exchange, TBIL rebound rate after plasma exchange of the first time, hepatorenal syndrome, hepatic encephalopathy, liver function indexes (PAB, ALB, ALT, AST, ALP, GGT, CHE, TBA, TBIL, DBIL) and blood lipid indexes (TCHOL, TG, HDL-C, LDL-C), blood coagulation function indexes (PT, INR, APTT), blood cell analysis indexes (WBC, RBC, HGB, PLT).We collect all the prognoses of patients with the plasma exchange therapy, the prognoses are assorted effective group and ineffective group.3. We quantify the various factors and establish the databases by using SPSS21.0 software:3.1The Univariate Analysis:enumeration data is used Chi-square Test; Measurement data:normal distribution between groups are compared with Independent Samples t-test, comparison between groups of skewness distribution use the rank and inspection.3.2 The Multivariate Analysis:We use the unconditioned Logistic regression model to selected corresponding independent factors, and establish the regression equation.3.3We draw the Receiver Operating Characteristic and calculate Area Under the Curve, to determine diagnosis efficiency and the critical value of each index showed that the diagnostic value of various factors.3.4 We apply correlation analysis to study the relation between factors.Results:1.The prognoses of 138 patients:86 cases (62.3%) are effective,and 52 cases (37.7%) are noneffective2. The results of The Univariate Analysis:2.1 Chi-square Test:the gender, age and the times of plasma exchange is not statistically significant difference between the groups (P> 0.05), the differences of the rebound rate, nosetiology types and ascites, hepatic encephalopathy and hepatorenal syndrome between groups are statistically significant (P< 0.05).2.2 Independent Samples t-test:The differences of HGB, ALB, CHE, PT Between two groups are statistically significant (P< 0.05), while the differences of PLT, TBA, TBIL, DBIL have no statistical significance (P> 0.05).2.3 Two Sample Rank Test:Between the two groups,the differences of WBC, RBC, TG, HDL-C, INR are statistically significant (P< 0.05), while the differences PAB, ALT, AST, ALP, GGT, TCHOL, LDL-C,APTT between two groups has no statistical significance (P> 0.05).3. Results of The Multivariate Analysis:14 influencing factors from the univariate analysis are introduced into unconditional Logistic regression model. Results show that:The nosetiology types, rebound rate, INR and ALB 4 factors have significant correlation with the effecacy of plasma exchange, they affect independently the efficacy of PE.4. Draw the ROC curve of the rebound rate, INR and ALBResult:Rebound rate (AUV= 0.714, P< 0.01), INR (AUV= 0.697, P< 0.01), propagated (AUV= 0.697, P< 0.01), which are all prognostic indexes for effecacy of plasma exchange, but the rebound rate has higher prognostic value. Calculate the Critical Value:the rebound rate= 28.73%, ALB= 32.15 g/L, INR= 2.245.5.Results of Correlation Analysis:ALB and ascites have negative correlation (r= 0.425, P< 0.01), ALB and CHE, TCHOL, TG, HDL-C have positive correlation, PT and INR have significant positive correlation; ALB has negative correlation with the efficacy of PE. Both INR and the rebound rate has negative correlation with the efficacy of PE.Conclusions:1. Autoimmune liver disease, the rebound rate after plasma exchange treatment for the first time, INR, ALB were independent affecting factors for the curative effect of plasma exchange therapy, and they have significant correlation with the effecacy of plasma exchange.1.1 Which compared to viral hepatitis, drug-induced liver disease, alcoholic liver disease, agnogenic liver disease, the effecacy of autoimmune liver disease with the plasma exchange treatment is worse, the patients of autoimmune liver disease can consider to use blood plasma adsorption treatment or combined treatment ,We consider blood purification combinates with standard medical treatment (Hormones, Ursodeoxycholic Acid, etc.) that be better.1.2 Patients with severe jaundice caused by liver disease, TBIL rebound rate is greater than 28.73%,Which is independent risk factors to affect the curative effect of plasma exchange, the TBIL rebound rate> 28.73% may indicates that the effect of plasma exchange treatment will be not good, and if the rebound rate is the greater and the effect may be worse.1.3 Patients with severe jaundice caused by liver disease, ALB> 32.15 g/L, the plasma exchange treatment effect is relatively good, ALB is tend to be normal, the curative effect of plasma exchange is the better.1.4 Patients with severe jaundice caused by liver disease, When INR> 2.245 indicated that the effect of plasma exchange is worse, INR is greater and the curative effect of plasma exchange is worse.1.5 The predicted plasma exchange effect valuable of rebound rate which be compared with ALB, INR is more.2. The patient’s gender, age, PAB, ALT, AST, TBA, TBIL, DBIL, ALP, GGT, TCHOL, LDL-C and APTT, PLT have no correlation with the effect of plasma exchange treatment.