The Effect Of Plasma Exchange Combined With Double Plasma Molecular Adsorption System(PE+DPMAS)on The Efficacy And Metabolomics Of Patients With Hepatitis B-related Acute-on-chronic Liver Failure

Objective:To investigate the effects of plasma exchange combined with dual plasma molecular adsorption system(PE+DPMAS)on metabolomics(amino acids,vitamins)and biochemical indexes in patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF).To evaluate the efficacy and safety of artificial liver.Methods:A retrospective study was conducted to include 150 patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)who were hospitalized in the Department of Hepatology,Nanchang Ninth Hospital from December 2019 to December 2022.Among them,50 were treated with internal medicine alone,50 were treated with internal medicine combined with PE+DPMAS(PE+DPMAS group),and 50 were treated with internal medicine combined with PE(PE group).The clinical data of the patients were collected to compare the clinical improvement rates of the three different treatment regimens.To clarify the adverse reactions of PE+DPMAS and PE artificial liver models and their effects on biochemical indicators and MELD scores.A prospective study was conducted to include 30 HBV-ACLF patients who were hospitalized in the Department of Hepatology,Nanchang Ninth Hospital from December 2021 to December 2022 and received PE+DPMAS treatment.The amino acid and vitamin indexes of the patients before and after the first PE+DPMAS treatment were detected by chromatography-mass spectrometry and analyzed.Results(1)After artificial liver treatment,the scores of ALT,AST,TBIL and MELD in the two groups were lower than those before treatment,and the PTA was higher than that before treatment,the differences were statistically significant(P<0.05).Compared with PE treatment,TBIL and MELD scores were lower and PTA level was higher after PE+DPMAS treatment(P<0.05).(2)The clinical improvement rate of PE+DPMAS group and PE group was higher than that of simple medical treatment group(P<0.05).Compared with PE treatment,PE+DPMAS treatment has fewer adverse reactions and is safer during treatment.(3)The levels of methionine and tyrosine in patients with HBV-ACLF were higher than normal levels,and arginine was lower than normal levels.After PE+DPMAS treatment,the concentration of methionine and tyrosine higher than normal level tended to normal range(P<0.05).(4)In the field of B vitamins,vitamin B1 and folic acid in HBV-ACLF patients were generally lower than normal levels,and vitamin B3 was higher than normal levels;after PE+DPMAS treatment,the high level of vitamin B3 concentration decreased and tended to normal level(P<0.05).In the field of fat-soluble vitamins,vitamin A and vitamin D in HBV-ACLF patients were seriously lower than normal levels,and the concentrations of vitamin A and 25-hydroxyvitamin D3 below normal levels were slightly increased after PE+DPMAS treatment(P<0.05).Conclusions:(1)Compared with PE treatment,PE+DPMAS can significantly improve the liver function and coagulation function of HBV-ACLF patients,and PE+DPMAS has fewer adverse reactions and is safer.(2)Tyrosine and methionine in patients with HBV-ACLF were higher than normal levels,and arginine was lower than normal levels.PE+DPMAS treatment can make high concentrations of tyrosine and methionine tend to be normal,improve amino acid metabolism disorders,and reduce the risk of hepatic encephalopathy.(3)HBV-ACLF patients are generally lack of vitamins,PE+DPMAS treatment can slightly change some vitamin levels,so that abnormal concentrations of vitamins tend to normal levels.(4)PE+DPMAS is a safe and effective artificial liver model.