[Meta-analysis of the therapeutic value of plasma exchange simple or combined with dual plasma molecular adsorption system for liver failure].

Objective: To systematically analyze the serological parameters, effective rate and survival rate of patients with liver failure after simple plasma exchange treatment and half-dose plasma exchange combined with dual plasma molecular adsorption system. Methods: Randomized controlled trials published in the full-text articles of Pubmed, Embase, Web of Science, The Cochrane Library, Wanfang, Weipu, CNKI, and other journals from June 2020 were retrieved. Revman 5.3 software was used to conduct the meta-analysis after the literature quality evaluation. Results: A total of 10 studies involving 884 cases were selected. Among them, 425 and 459 were treated with combination and simple plasma exchange therapy. The levels of TBIL (MD=-28.58, 95% CI: -37.42～-19.75, P<0.000 01) and ALB (MD=-2.00, 95%CI:-2.61～-1.39, P<0.000 01) were lower in the combined treatment group than those in the simple treatment group, and the difference was statistically significant. HGB (MD=5.96, 95%CI: 1.52-10.40, P=0.009), effective rate (OR=1.92, 95%CI: 1.29-2.85, P=0.001), and survival rate (OR=1.63, 95%CI: 1.13-2.36, P=0.009) were higher in the combined treatment group than those in the simple treatment group, and the difference was statistically significant.The two treatment methods had good curative effects for the improvement of ALT, AST, DBIL, PTA, INR, and PLT levels (P＜0.05), and there was no statistically significant difference between them (P＞0.05). Conclusion: Half-dose plasma exchange combined with dual plasma molecular adsorption system therapy not only effectively improves hyperbilirubinemia, efficacy, and survival rate while significantly reducing plasma dosage, but it also has fewer adverse effects on hemoglobin depletion in patients with liver failure than simple plasma exchange therapy.目的： 系统分析单纯血浆置换治疗与半量血浆置换联合双重血浆分子吸附系统治疗后肝衰竭患者血清学指标、有效率和生存率。 方法： 检索建库至2020年6月在Pubmed、Embase、Web of Science、The Cochrane Library、万方、维普、中国知网期刊全文数据库中公开发表的关于本研究的随机对照试验，经文献质量评价后，采用Revman5.3软件进行Meta分析。 结果： 共纳入10篇文献，884例患者，其中425例采用联合治疗，459例采用单纯血浆置换治疗。联合治疗组总胆红素（MD=-28.58，95%CI：-37.42～-19.75，P<0.01）和白蛋白（MD=-2.00，95%CI：-2.61～-1.39，P<0.01）水平低于单纯治疗组，差异有统计学意义；联合治疗组血红蛋白（MD=5.96，95%CI：1.52～10.40，P=0.009）、有效率（OR=1.92，95%CI：1.29～2.85，P=0.001）、生存率（OR=1.63，95%CI：1.13～2.36，P=0.009）均高于单纯治疗组，差异均有统计学意义；两种治疗方式对患者丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、直接胆红素、凝血酶原活动度、凝血酶原时间国际标准化比值、血小板水平的改善均有较好的疗效（P<0.05），两者之间差异无统计学意义（P>0.05）。 结论： 相较于单纯血浆置换治疗，半量血浆置换联合双重血浆分子吸附系统治疗不仅可以有效改善高胆红素血症、提高有效率和生存率、显著减少血浆用量，而且对肝衰竭患者血红蛋白下降影响更小。.