这项荟萃分析旨在评估双血浆分子吸附系统(DPMAS)联合血浆置换(PE)与单独血浆置换治疗由乙型肝炎引起的急性对慢性肝衰竭(LF)的有效性。直到2023年8月31日,包括Embase在内的数据库的全面搜索,中国医学杂志全文数据库,中国生物医学文献数据库,万方医学网,PubMed,Cochrane图书馆使用的关键词是“肝功能衰竭”,慢性急性肝衰竭,\"\"PE,\"\"DPMAS,”和相关术语。使用QUADS(诊断准确性研究的质量评估)评估纳入研究的质量。软件Revman5.3用于检查数据,而Stata15.1用于运行Egger的测试。经过彻底的筛查,包括452例仅接受PE的患者和429例除PE外还接受DPMAS的患者。纳入的每一项研究都是高水平的。当比较DPMAS+PE组与单独PE组时,总胆红素下降幅度明显更高(平均差[MD]=-49.09,95%置信区间[CI]:-54.84~-43.35,p<.00001).凝血酶原活性(PTA;MD=-1.53,95%CI:-3.29至-0.22,p=.09),白蛋白(ALB;MD=-0.58,95%CI:-1.57至0.41,p=0.25),凝血酶原时间(PT;MD=-0.07,95%CI:-1.47至1.34,p=0.92),和血小板计数(PLT;MD=-0.08,95%CI:-1.33至1.66,p=.90)没有显著差异。PE组的国际标准化比率(INR)的改善明显更大(MD=0.07,95%CI(0.03,0.10),p=.0001)。当与DPMAS结合使用时,PE已被证明在降低总胆红素水平方面更有效。PE还可以降低患有乙型肝炎相关ACLF的个体的INR。这种治疗策略还减少了对血浆输血的需要。
This meta-analysis aims to evaluate the effectiveness of the double plasma molecular adsorption system (DPMAS) in combination with plasma exchange (PE) compared to plasma exchange alone in the treatment of Acute-on-Chronic liver failure (LF) caused by hepatitis B. Until August 31, 2023, a comprehensive search of databases including Embase, Chinese Medical Journal Full-text Database, China Biomedical Literature Database, Wan Fang Medical Network, PubMed, and the Cochrane Library was carried out using keywords like \"liver failure,\" \"acute-on-chronic liver failure,\" \"PE,\" \"DPMAS,\" and related terms. The quality of the included studies was evaluated using QUADS (quality assessment of diagnostic accuracy studies). Software Revman 5.3 was used to examine the data, while Stata 15.1 was used to run Egger\'s test. Following thorough screening, 452 patients who received PE alone and 429 patients who received DPMAS in addition to PE were included. Every study that was included was of a high caliber. When comparing the DPMAS plus PE group to the PE alone group, the total bilirubin reduction was considerably higher (mean difference [MD] = -49.09, 95% confidence interval [CI]: -54.84 to -43.35, p < .00001). Prothrombin activity (PTA; MD = -1.53, 95% CI: -3.29 to -0.22, p = .09), albumin (ALB; MD = -0.58, 95% CI: -1.57 to 0.41, p = .25), prothrombin time (PT; MD = -0.07, 95% CI: -1.47 to 1.34, p = .92), and platelet count (PLT; MD = -0.08, 95% CI: -1.33 to 1.66, p = .90) did not differ significantly. The improvement in international standardized ratio (INR) was significantly greater in the PE group (MD = 0.07, 95% CI (0.03, 0.10), p = .0001). When combined with DPMAS, PE has been shown to be more effective in lowering total bilirubin levels. PE can also lower INR in individuals who have hepatitis B-related ACLF. This therapeutic strategy also lessens the need for plasma transfusions.