半量血浆置换联合双重血浆分子吸附系统改善慢加急性肝衰竭的预后研究OA

Objective:To investigate the predictive efficacy of serum cytokeratin 18(CK18)in the short-term prognosis of patients with acute-on-chronicliverfailure(ACLF)treated with half volume plasma exchange(HPE)combined with double plasma molecular adsorption system(DPMAS).Methods:A total of 116 patients diagnosed with ACLF were selected from the Third Hospital of Hebei Medical University,and divided into control group and observation group according to treatment methods.General clinical data and clinical indicators such as serology before and after artificial liver treatment were collected and analyzed.The observation group was divided into a better group and a worse group.Laboratory examination,M65,M30 and other related serological indicators were analyzed before and after artificial liver treatment in the two groups,and the diagnostic efficacy of prognosis prediction was analyzed by receiver operating characteristic curve(ROC curve).Results:1.116 ACLF patients were followed up for 3 months.PLT and PTA levels in observation group were significantly increased compared with control group(P＜0.05),while ALT,AST,TBIL and INR were significantly decreased compared with control group(P＜0.05).The 28 d survival rate of observation group was significantly higher than that of control group(P＜0.05).2.The scores of M65,M30,ALT,AST,TBil,GGT,PT,INR and MELD in the observation group were significantly decreased compared with those before treatment(P＜0.05),and PLT was significantly increased;3.M65,M30,ALT,AST,TBIL and INR in worsening group were significantly higher than those in improving group(all P＜0.05),and were negatively correlated with disease prognosis(r=-0.553,-0.558,-0.308,-0.307,-0.322,-0.307,all P＜0.05).AFP was significantly lower than that in the improved group,and was positively correlated with the prognosis of ACLF(r=0.386,P=0.043).4.M65 has high diagnostic efficacy in predicting disease prognosis,with AUC of 0.826,high sensitivity of 0.850,specificity of 0.789,and cut-off value of 704.8 U/L.When combined with M65,M30 and AFP,the diagnostic efficacy to predict the prognosis of patients was the highest,with AUC of 0.920,sensitivity and specificity of 0.870 and 0.850 respectively.Conclusion:HPE combined with DPMAS treatment improves the liver function and coagulation function of patients,thereby increasing their survival rate.