血浆交换和双血浆分子吸收系统治疗免疫检查点抑制剂相关性肝炎的疗效

IF 0.3 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY

Hepatitis Monthly Pub Date : 2023-10-25 DOI:10.5812/hepatmon-137153

Ying Liu, Lihua Zheng, Wenxiong Xu, Qihuan Xu, Xinhua Li, Qu Lin, Lu Wang, Jing Lai

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引用次数: 0

摘要

背景:免疫检查点抑制剂(ICI)相关肝炎在过去十年中呈上升趋势。目的:本研究旨在探讨血浆置换(PE)和双血浆分子吸收系统(DPMAS)治疗ici相关性肝炎的有效性。方法:对中山大学第三附属医院治疗的ici相关性肝炎患者进行回顾性分析。收集的数据包括生化指标、治疗、人工肝支持系统(ALSS)的使用和结果。结果:从2021年6月到2023年1月，16例患者接受治疗并纳入分析。A组8例患者给予一般支持。B组8例患者给予一般支持，每2 ~ 4天加3轮ALSS治疗(4例患者采用PE治疗，其余患者采用DPMAS + PE治疗)。两组患者的年龄和治疗天数无显著差异。治疗前，A组与B组患者直接胆红素(DBIL)、谷氨酰胺转肽酶(GGT)、碱性磷酸酶(ALP)、天冬氨酸转氨酶、丙氨酸转氨酶(ALT)、降钙素原、国际标准化比值(INR)、终末期肝病模型评分、白蛋白、球蛋白、血细胞计数均无显著差异(P >0.05)。但B组总胆红素(TBIL)显著高于A组(P = 0.029)。治疗后，B组TBIL和DBIL均显著降低(P <B组GGT显著低于a组(P = 0.028)， INR显著高于a组(P = 0.004)。B组ALP也显著低于a组，但差异无统计学意义(P = 0.068)。未见过敏反应及严重不良反应。结论:PE和DPMAS + PE均能在短期内有效改善ici相关性肝炎，且对高胆红素血症患者更有效。治疗期间应持续监测肝功能。

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Efficacy of Plasma Exchange and a Double-Plasma Molecular Absorption System for Treating Immune Checkpoint Inhibitor-Related Hepatitis

Background: Immune checkpoint inhibitor (ICI)-related hepatitis has been increasing in the past decade. Objectives: This study aimed to investigate the effectiveness of plasma exchange (PE) and a double-plasma molecular absorption system (DPMAS) for ICI-related hepatitis. Methods: A retrospective analysis was conducted on patients with ICI-related hepatitis treated at the Third Affiliated Hospital of Sun Yat-Sen University (China). The collected data included biochemical indices, treatments, the use of an artificial liver support system (ALSS), and outcomes. Results: From June 2021 to January 2023, 16 patients were treated and included in the analysis. Eight patients in group A received general support. The other 8 patients in group B received general support, plus 3 rounds of ALSS every 2 - 4 days (4 patients were treated with PE and the others with DPMAS + PE). There was no significant difference in age and treatment days between the two groups. Before treatment, there was no significant difference in direct bilirubin (DBIL), glutamine transpeptidase (GGT), alkaline phosphatase (ALP), aspartate transaminase, alanine transaminase (ALT), procalcitonin, the international normalized ratio (INR), model for end-stage liver disease scores, albumin, globulin, and hemocyte count between groups A and B (in all cases, P > 0.05). However, the total bilirubin (TBIL) of group B was significantly higher than that of group A (P = 0.029). After treatment, TBIL and DBIL were significantly decreased in group B (both P < 0.05), and group B had a significantly lower GGT (P = 0.028) and higher INR (P = 0.004) than group A. The ALP level of group B was also lower, but the difference was not significant (P = 0.068). No allergic reaction or severe adverse effect was observed. Conclusions: Both PE and DPMAS + PE can effectively improve ICI-related hepatitis within the short term and are more effective for patients with hyperbilirubinemia. Liver function should be monitored continuously during treatment.

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来源期刊

Hepatitis Monthly 医学-胃肠肝病学

CiteScore

1.50

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： Hepatitis Monthly is a clinical journal which is informative to all practitioners like gastroenterologists, hepatologists and infectious disease specialists and internists. This authoritative clinical journal was founded by Professor Seyed-Moayed Alavian in 2002. The Journal context is devoted to the particular compilation of the latest worldwide and interdisciplinary approach and findings including original manuscripts, meta-analyses and reviews, health economic papers, debates and consensus statements of the clinical relevance of hepatological field especially liver diseases. In addition, consensus evidential reports not only highlight the new observations, original research, and results accompanied by innovative treatments and all the other relevant topics but also include highlighting disease mechanisms or important clinical observations and letters on articles published in the journal.