临床肝胆病杂志2025，Vol.41Issue(10)：2093-2101,9.DOI:10.12449/JCH251020
CA280型细胞因子吸附柱治疗慢加急性肝衰竭的效果及安全性探讨
Efficacy and safety of CA280 cytokine adsorption column in treatment of acute-on-chronic liver failure
摘要
Abstract
Objective To investigate the application of the novel inflammatory factor adsorption column CA280 combined with low-dose plasma exchange(LPE)in patients with acute-on-chronic liver failure(ACLF).Methods A prospective cohort study was designed,and a total of 93 ACLF patients who were admitted to The Ninth Hospital of Nanchang from June 2023 to January 2025 were enrolled and randomly divided into DPMAS+LPE group with 50 patients and CA280+LPE group with 43 patients.In addition to comprehensive medical treatment,the patients in the DPMAS+LPE group received DPMAS and LPE treatment,and those in the CA280+LPE group received CA280 and LPE treatment.The two groups were observed in terms of routine blood test results,liver function parameters,renal function markers,electrolytes,coagulation function parameters,cytokines,adverse events,and 28-day prognosis before surgery(baseline),during surgery(DPMAS or CA280),and after surgery(after sequential LPE treatment).The paired t-test was used for comparison of normally distributed continuous data before and after treatment within each group,and the independent-samples t test was used for comparison between groups;the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment within each group,and the Mann-Whitney U test was used for comparison between groups.The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups,and the Spearman test was used for correlation analysis.Results After CA280 treatment,the ACLF patients had significant reductions in the levels of cytokines(IL-6,IL-8,IL-10,TNF-α,and IFN-γ),liver function parameters(ALT,AST,ALP,TBil,DBil,Alb,and glutathione reductase),and the renal function marker urea nitrogen(all P<0.05),and in terms of coagulation function parameters,there were significant increases in prothrombin time,activated partial thromboplastin time(APTT),thrombin time,and international normalized ratio(INR)and significant reductions in prothrombin activity(PTA)and fibrinogen(FIB)(all P<0.05).Compared with the DPMAS+LPE group,the CA280+LPE group showed better improvements in the serum cytokines IL-8(Z=-2.63,P=0.009),IL-10(Z=-3.94,P<0.001),and TNF-α(Z=-1.53,P=0.023),and the two artificial liver support systems had a similar effect in improving liver function(ALT,AST,GGT,GR,TBil,and DBil)(all P>0.05),but the CA280+LPE group showed a significantly greater reduction in Alb(Z=-2.08,P=0.037).CA280+LPE was more effective in reducing uric acid(Z=-2.97,P=0.003).Compared with DPMAS+LPE,CA280+LPE treatment resulted in a significant reduction in INR(Z=-4.01,P<0.001),a significant increase in APTT(Z=-2.53,P=0.011),and significant greater increases in PTA(Z=-6.28,P<0.001)and FIB(Z=-3.93,P<0.001).There were no significant differences in the incidence rates of adverse reactions and the rate of improvement at discharge between the two groups(all P>0.05).The Spearman correlation analysis showed that IL-6 was significantly correlated with WBC(r=0.22,P=0.042),TBil(r=0.29,P=0.005),and FIB(r=-0.33,P=0.003);IL-8 was positively correlated with APTT(r=0.37,P<0.001)and INR(r=0.25,P=0.013);TNF-α was significantly correlated with WBC(r=0.40,P<0.001)and TBil(r=0.34,P<0.001).Conclusion Compared with DPMAS,CA280 combined with LPE can effectively clear proinflammatory cytokines and improve liver function in ACLF patients,but it has a certain impact on Alb and coagulation function.This regimen provides a new option for the individualized treatment of ACLF and can improve the short-term prognosis of patients,but further studies are needed to verify its long-term efficacy.关键词
慢加急性肝功能衰竭/肝,人工/细胞因子吸附Key words
Acute-On-Chronic Liver Failure/Liver,Artificial/Cytokine Adsorption引用本文复制引用
何妍,刘双烂,江西子,卢瑜诗,熊墨龙,熊云逢,甘达凯,张晓青,龙涛,张雪珍,张伟,徐意珍,曾雨雨,周锐..CA280型细胞因子吸附柱治疗慢加急性肝衰竭的效果及安全性探讨[J].临床肝胆病杂志,2025,41(10):2093-2101,9.基金项目
北京肝胆相照公益基金会项目(iGandanF-1082023-RGG035) Beijing Liver-Gallbladder Xiangzhao Charity Foundation(iGandanF-1082023-RGG035) （iGandanF-1082023-RGG035）
