Clinical Efficacy And Prognosis Analysis Of Non-bioartificial Liver Support System For Primary Biliary Cholangitis

Objectives:Primary biliary cholangitis(PBC)is a chronic autoimmune liver disease.The pathogenesis of PBC is unclear still now,many researches indicated that is associated with infection,heredity and environmental factors.The main pathological features of PBC are cholestasis and progressive destruction of intrahepatic bile ducts.Ursodeoxycholic acid(UDCA)is the first-line drug for the PBC treatment,while about 30-40%of patients do not respond well to UDCA.Furthermore,most patients will progress to the stage of liver fibrosis,cirrhosis,hepatocellular carcinoma,and liver failure.When the patient progresses to liver failure,lots complications,such as hyperbilirubinemia,coagulation dysfunction,hepatic encephalopathy will occur,and the disease progress rapidly,the prognosis should be worse.Liver transplantation is an effective method,but it is often difficult to achieve.Artificial liver support system(ALSS),as the bridge for liver transplantation,it can replace part of liver function and create opportunities for hepatocyte regeneration and liver function recovery.However,there are few studies on ALSS and PBC.This study aims to retrospectively analyze the clinical data of PBC patients treated through plasma exchange(PE)and double plasma molecular absorption system(DPMAS).Propensity-score matched(PSM)was used to select the patients treated with drugs as control group,in order to explore the relevant factors affecting the prognosis,provide a basis for the clinical application of artificial liver treatment in PBC patients.Method:This study retrospectively analyzed the clinical data of 526 PBC patients in our hospital from December 2013 to January 2021,selected 48 patients of PBC with artificial liver treatment as the experimental group.The control group included 73 patients of PBC with medical treatment in the past 1 year.After propensity matching,there were 43 patients in the experimental group and 43 patients in the control group.Then we compared the clinical symptoms,laboratory indexes and MELD score changes between two groups before and after treatment,evaluated the clinical efficacy of artificial liver treatment in PBC patients.After that,we explored the outcome of PE and DPMAS.Safety was assessed through recording adverse reactions of artificial liver.The cumulative survival rates at 3,6 and 12 months were compared between the two groups.At lsat,the relevant factors affecting the prognosis were analyzed.Result:1.Clinical symptomsAfter treatment,symptoms(fatigue,poor appetite,abdominal distension,abdominal pain,and pruritus)of patient in drug combined with artificial liver treatment group and drug treatment group were relieved,and there was no statistical significance between two groups(P>0.05).2.Laboratory indexes and MELD scoresThe level of ALB,ALT,AST and TBIL were decreased(P<0.05);The level of WBC was increased,RBC,Hb and PTL were decreased(P<0.05).The level of PTA was increased and that of INR was decreased(P<0.05).The level of PCT and hsCRP were decreased(P<0.05).MELD score was decreased(P<0.05)in drug combined with artificial liver group.3.The decline rate of serological indicator after PE and DPMAS treatmentThe decrease rates of ALB,ALT,AST and ALP in PE group were higher than that of DPMAS group(P<0.05).4.Clinical efficacyThe effective rate in the medicine group was 55.8%,the effective rate in drug combined with artificial liver treatment group was 76.7%,the efficiency in drug combined with artificial liver treatment group was better than medical treatment group,the difference was statistically significant(χ2=4.214,P=0.040).5.Adverse reactions11 adverse reactions were observed in 101 times of artificial liver treatment,including 5 bleeding and swelling,3 allergy,2 convulsion and 1 hypotension.6.Survival analysisThe survival rate of patients in the drug combined with artificial liver treatment group in 3,6 and 12 months was higher than that of the drug treatment group.7.Analysis of prognostic factorsMultivariate Cox proportional risk regression analysis showed that TBil was an independent risk factor affecting the survival of PBC patients in 3,6 and 12 months.In addition,PTA and MELD scores were also independent risk factors affecting the survival of PBC patients in 6 months.Conclusions:1.Artificial liver support system can relieve PBC patients’ clinical symptoms such as poor tolerance and fatigue,effectively reduce ALT,AST and TBIL,correct patients’blood coagulation function,and reduce the MELD scores.2.In PBC patients,artificial liver support system is safe and effective.3.The survival outcomes of PBC patients could be improved through artificial liver support system in 3,6 and 12 months.TBil was an independent risk factor affecting the survival of PBC patients in 3,6 and 12 months.In addition,PTA and MELD scores were also independent risk factors affecting the survival of PBC patients in 6 months.