Effects of plasma exchange followed by double plasma molecular adsorption system on cytokines in patients with hepatitis B virus-related acute-on-chronic liver failure
10.3969/j.issn.1008-9691.2025.02.013
- VernacularTitle:血浆置换序贯双重血浆分子吸附系统对乙型肝炎病毒相关慢加急性肝衰竭患者细胞因子的影响
- Author:
Le ZHANG
1
;
Kaiyi ZHANG
1
;
Yushan LI
1
;
Jiawei XIA
1
;
Hanzhang SHEN
1
;
Xiang LI
1
Author Information
1. 昆明市第三人民医院,云南 昆明 650041;云南省传染性疾病临床医学中心,云南 昆明 650041
- Publication Type:Journal Article
- Keywords:
Plasma exchange followed by double plasma molecular adsorption system;
Hepatitis B virus;
Acute-on-chronic liver failure;
Cytokine
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2025;32(2):196-200
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the significance of immunotherapy for patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)using plasma exchange(PE)followed by double plasma molecular adsorption system(DPMAS),as well as its impact on prognosis.Methods Patients who were admitted to the Third People's Hospital of Kunming from June 2019 to June 2023 and met the early and mid-stage diagnostic criteria for HBV-ACLF were selected as the research subjects,with a total of 120 cases.After admission,the patients were divided into the PE+DPMAS group(PD group,63 cases)and the PE group(57 cases)based on different treatment plans.The changes in liver function,coagulation function,cytokines,and model for end-stage liver disease(MELD)scores after treatment,as well as the clinical improvement rates,were observed in both groups.Results ① After treatment,the levels of serum total bilirubin(TBil)in the PD group were significantly lower than those in the PE group(μmol/L:163.4±53.3 vs.226.1±72.5,P<0.05),and the prothrombin activity(PTA)was significantly increased[(51.5±9.2)%vs.(41.1±7.7)%,P<0.05].②After treatment,the levels of interleukins(IL-2,IL-6,IL-8)and tumor necrosis factor-α(TNF-α)in both groups decreased compared to before treatment at 1,2,and 4 weeks,reaching the lowest levels at 4 weeks,the levels of IL-2,IL-6,IL-8,and TNF-α in the PD group were lower than those in the PE group[IL-2(ng/L):1.83(1.75)vs.2.04(1.85),IL-6(ng/L):11.31(5.07)vs.18.18(9.05),IL-8(ng/L):21.14(8.35)vs.29.09(12.41),TNF-α(ng/L):9.16(5.10)vs.14.12(7.27)].The levels of IL-10 decreased at 1 week and 2 weeks after treatment.In the PD group,IL-10 increased at 4 weeks after treatment.The differences compared to the baseline levels before treatment were statistically significant(P<0.05).At 4 weeks after treatment,the level of IL-10 in the PD group was significantly higher than that in the PE group[ng/L:24.72(11.56)vs.19.03(10.04),P<0.05].③ The clinical improvement rates in the PD group were significantly higher than those in the PE group at 2 weeks and 4 weeks after treatment[2 weeks after treatment:65.08%(41/63)vs.40.35%(23/57);4 weeks after treatment:84.13%(53/63)vs.54.39%(31/57),both P<0.05].④After 4 weeks of treatment,the MELD scores in both groups decreased significantly.Compared with the PE group,the MELD score in the PD group was significantly lower(14.87±3.45 vs.19.68±4.63,P<0.05).Conclusion Compared with PE alone,PE+DPMAS treatment for early and mid-stage ACLF patients can more effectively clear the large amount of inflammatory mediators released in the body,better regulate the balance between pro-inflammatory and anti-inflammatory cytokines in the patient's serum,thereby preventing or delaying the formation of systemic inflammatory response syndrome(SIRS)and multiple organ dysfunction syndrome(MODS).The clinical therapeutic effect is better,with a higher improvement rate,achieving the goal of reducing liver damage,improving patient survival rate,and thus improving prognosis.
