血浆交换人工肝治疗慢加急性肝衰竭患者的临床特征及疗效分析

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中图分类号：R446.6 文献标志码：A DOI：10.7652/jdyxb202504017

ABSTRACT：ObjectiveTo observe the clinical characteristics and eficacy of plasma exchange artificial liver therapy in patients with acute-on-chronic liver failure（ACLF）. MethodsA total of 135 patients with ACLF treated i ourhospitalfrom May 2O23 to May2O24were selectedas the studysubjects.They were divided into two groups based on diferent treatment methods：plasma exchange artificial liver therapy group（54 cases）and conventional therapy group （8l cases）.Patients received diferent treatment according their liver function and coagulation function.We compared the laboratory test results，clinical efficacy，cytokine levels，and incidence of complications between the two groups of patients.ResultsThe MELD score of patients was significantly higher in the artificial liver treatment group （2527.96±1504.21） than in the conventional group （1854.75±940.23） ）（ P= O.004），and the incidence of diabetes，coronary heart disease and liver cancer in the former group was significantly higher than that in the latter group （ P=0.030 ，O.03o）.The total serum bilirubin，direct bilirubin，interleukin-6 （IL-6），C-reactive protein（CRP），alpha fetoprotein，lymphocyte/monocyte ratio，and direct bilirubin/partial thromboplastin time ratio（PTR）in the artificial liver treatment group were significantly higher than those in the conventional group（ P values <0.001 <0.001 ，0.040，O.o30，O.04O，andO.oo6，respetively），whileuricacid levels were significantly lower than those in the conventional group （ P=0.040： .The artificial liver treatment group had significantly lower incidence of infection and ascites during treatment than the conventional group （ P=0.010 ， O.020）.After artificial liver treatment，the patients’levels of IL-6，CRP，and alpha fetoprotein were significantly reduced.ConclusionPatients with complex chronic and acute liver failure are more recommended to directly undergo plasma exchange artificial liver treatment，which has definite efficacy and fewer complications.IL-6，CRP andalpha fetoproteindynamically monitored canbe regarded as indicators for efficacyof artificial liver treatment.

KEY WORDS：artificial liver therapy；acute-on-chronic liver failure （ACLF）；model for end-stage liver disease （MELD）score；complication

慢加急性肝衰竭（acute-on-chronicliverfailure，ACLF）是指本身患有慢性肝病但肝功能相对稳定的患者短时间内进展为严重的肝功能障碍，病情加速恶化，通常伴发肝脏和肝外器官衰竭，病死率短期急剧升高[]。（剩余8241字）