Clinical Study On Double Plasma Molecular Adsorption System Plus Plasma Exchange In Treatment Of Acute-on-chronic Liver Failure

Objective:To study the clinical efficacy of plasma exchange,doubleplasma molecular adsorption system and double plasma molecular adsorption system plus plasma exchange to treat patients with acute-on-chronic liver failure.Methods:A total of 140 patients with acute-on-chronic liver failure,who visited the hepatopathy department of our hospital in January 2013-December2014.All patients received routine examination and medical comprehensive treatment after hospitalization.The enrolled patients were randomly into three groups,including Group A,Group B and Group C.Patients in Group A received plasma exchange,patients in Group B received double plasma molecular adsorption system,and patients in Group C received double plasma molecular adsorption system plus plasma exchange.All patients received one treatment per 2⁴ days.The investigation including hepatic function indicators（ALT,AST,GGT,ALP,GLB and TBIL）,coagulation indicators（PT）,electrolyte(K⁺,Na⁺,Cl^-and Ca²⁺),Blood indicators（WBC,HGB,PLT,BA and AFP）.The proportion of clinical symptoms and signs（debilitation,anorexia,abdominal distension,oliguria,bleeding tendency,ascites and hepatic encephalopathy）were observed before treatment,and in 2^nd,4^th,12^th,24^th and 48^th after treatment.The clinical prognosis in 2^nd and 4^th week after treatment were compared in three groups.Survival rate in 2^nd,4^th,12^th,24^th and 48^th week after treatment were compared in three groups.Results:（1）The proportion of clinical symptoms and signs（debilitation,anorexia,abdominal distension,oliguria and ascites）in Group C was much lower than those in Group A and Group B（P<0.05）.（2）The clinical effective rates were significantly different in 2^nd and 4^th week after treatment in three groups（P<0.05）,and the clinical effective rates in Group C was much higher than those in Group A and Group B（P<0.05）.（3）Survival rates in three groups were not significantly different in 2^nd,4^th,12^th,24^th and48^th week after treatment in three groups（P>0.05）.（4）The levels of ALT,AST,TBIL,GGT and ALP were not significantly different before treatment,and in 2^nd,4^th,12^th,24^th and 48^th week after treatment in three groups（P>0.05）.The level of GLB was not significantly different before treatment（P>0.05）,but The level of GLB in Group C was much higher than that in Group A and Group B in 2^nd,4^th,12^th,24^th and 48^th week after treatment in three groups（P<0.05）.（5）The levels of PT,WBC,HGB and PLT were not significantly different before treatment,and in 2^nd,4^th,12^th,24^th and 48^th week after treatment in three groups（P>0.05）.（6）The levels of K⁺,Na⁺,Cl^-and Ca²⁺were not significantly different before treatment,and in 2^nd,4^th,12^th,24^th and 48^th week after treatment in three groups（P>0.05）.（7）The levels of BA and AFP were not significantly different before treatment,and in2^nd,4^th,12^th,24^th and 48^th week after treatment in three groups（P>0.05）.Conclusion:（1）Double plasma molecular adsorption system plus plasma exchange can effectively improve the heptic function in patients with acute-on-chronic liver failure and have better short-time clinical efficacy;（2）Double plasma molecular adsorption system plus plasma exchange have better effect of improving clinical symptoms and signs compared with plasma exchange or double plasma molecular adsorption system.（3）Double plasma molecular adsorption system plus plasma exchange can significantly reduce the plasmic amount compared with plasma exchange in patients with acute-on-chronic liver failure.（4）Double plasma molecular adsorption system plus plasma exchange can not significantly improve the survival of patients with acute-on-chronic liver failure compared with double plasma molecular adsorption system or plasma exchange.