人工肝支持系统在高胆红素血症患者中的疗效及预后分析OA

Objective To evaluate the efficacy of an artificial liver support system(ALSS)in patients with hy-perbilirubinemia and to identify independent risk factors associated with 24-week mortality.Methods A retrospective analysis was conducted in 106 patients with hyperbilirubinemia who received ALSS treatment.According to their 24-week outcomes,patients were divided into a mortality group(n=44)and a survival group(n=62).Baseline characteristics were compared between the two groups,and multivariate logistic regression analysis was performed to identify independent risk factors for 24-week mortality.The therapeutic efficacy of different treatment frequencies(1 session,2-4 sessions,and ≥5 sessions)and treatment modalities,including double plasma molecular adsorption system(DPMAS)and DPMAS combined with plasma exchange(DPMAS+PE),was also evaluated.Results After ALSS treatment,total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)levels were significantly decreased(P＜0.05).However,there were no significant differences in 24-week survival rates among patients receiving different numbers of treatment sessions or treatment modalities(all P＞0.05).Multivariate logistic regression analysis showed that concomitant cirrhosis(OR=6.245),concomitant hepatocellular carcinoma(OR=6.820),higher baseline Model for End-Stage Liver Disease(MELD)score(OR=1.125),and higher prothrombin time-to-albumin ratio(PTAR)(OR=1.228)were independent risk factors for 24-week mortality(all P＜0.05).Conclusion ALSS can effectively reduce bilirubin and aminotransferase levels in patients with hyperbilirubinemia.However,long-term prognosis does not appear to be associated with the frequency or modality of ALSS treatment,but is primarily determined by underlying liver diseases,particularly cirrhosis and hepatocellular carcinoma,as well as the MELD score and PTAR,which reflect hepatic function and overall clinical status.