PE与DPMAS治疗肝衰竭的临床疗效对比及WBC、NLR的影响

目的:研究血浆置换(plasma exchange,PE)与双重血浆分子吸附系统(double plasma molecular adsorption system,DPMAS)治疗肝衰竭的临床疗效以及对白细胞(white blood cells,WBC)、中性粒细胞与淋巴细胞的比值(neutrophil to lymphocyte ratio,NLR)的影响。方法:选取2017年1月至2019年12月期间我院收治的170例肝衰竭患者,采用随机数字表法分为对照组和观察组,对照组64例,观察组106例。两组患者均给予内科综合治疗,对照组采取PE治疗方案,观察组采取DPMAS治疗方案,对比两组患者的疗效。分别于治疗前后检测两组患者肝功能指标、凝血功能指标、电解质水平、WBC和NLR值。观察并记录两组患者治疗期间发生的不良反应。结果:治疗后两组患者的总有效率无统计学差异(P0.05)。治疗后两组患者的血清谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(aspartate transaminase,AST)和总胆红素(total bilirubin,TBIL)的水平均显著下降(P0.05);与对照组治疗后相比,观察组治疗后患者的血清ALT、AST无统计学差异(P0.05),而TBIL的表达水平较低(P0.05)。对照组治疗后凝血酶原时间(prothrombin time,PT)与治疗前无统计学差异(P0.05),而凝血酶原活动度(prothrombin activity,PTA)显著高于治疗前(P0.05);观察组治疗后的PT和PTA与治疗前相比均有统计学差异(P0.05)。治疗后对照组Na+和K+水平与治疗前无统计学差异(P0.05),而Cl-水平显著下降(P0.05);观察组治疗后K+和Cl-水平与治疗前相比无统计学差异(P0.05),而Na+水平显著下降(P0.05)。两组患者治疗后WBC值无统计学差异(P0.05);两组患者治疗后NLR均显著降低(P0.05)。两组患者不良反应总发生率无统计学差异(P0.05)。结论:PE和DPMAS对肝衰竭均具有显著的的临床疗效,均可显著改善肝功能,降低NLR,但两种治疗方案对凝血功能、电解质等部分指标的影响不一,在实际应用中应综合考虑,权衡利弊,选取应用最合适的治疗方案以达到最佳疗效。

Comparison of Clinical Efficacy and Effect on WBC and NLR of PE and DPMAS in the Treatment of Liver Failure

ABSTRACT Objective: To investigate the clinical efficacy of plasma exchange(PE) and double plasma molecular adsorption system(DPMAS) and their effects on WBC and neutrophil to lymphocyte ratio(NLR) in the treatment of liver failure. Methods: 170 patients with liver failure admitted to our hospital from January 2017 to December 2019 were randomly divived into the control group and observation group, with 64 cases for control group and 106 cases for observation group. Both groups were treated with comprehensive physical treatment, the control group was treated with PE and observation group was treated with DPMAS, the clinical efficacy of two groups were compared. The liver function indexes, coagulation function indexes, electrolyte levels, WBC and NLR of two groups were detected before and after the treatment. The adverse reactions of all patients were recorded during the treatment. Results: The total efficacy rate of two groups had no significant difference(P>0.05). The expression of serum alanine transaminase(ALT), aspartate transaminase(AST) and total bilirubin(TBIL) of two groups were decreased after the treatment(P<0.05), compared with control group, the ALT and AST of observation group had no difference after the treatment(P>0.05) while TBIL was much lower(P<0.05). The prothrombin activity(PTA) of control group was increased after the treatment(P<0.05), the prothrombin time(PT) and PTA of observation group were significantly different comparing with pre-treatment(P<0.05). The Cl^- of control group was decreased after the treatment(P<0.05), and the Na⁺ of observation group was decreased after the treatment(P<0.05). The WBC of two groups had no significant difference after the treatment(P>0.05), and the NLR of two groups were decreased after the treatment(P<0.05). The incidence of adverse reactions of two groups had no significant difference (P>0.05). Conclusion: Both PE and DPMAS had significant clinical efficacy in the treatment of liver failure, the liver function was improved and the NLR was decreased, but the coagulation function indexes and electrolyte levels were different, we should weigh the advantage and disadvantage to choose the most suitable treatment to achieve the best curative effect.