Efficacy and Safety of Plasma Exchange for Chronic Liver Failure: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHENGZhi-ling ¹ , SUNGui-xiang ¹ , LINHui ² , LUYao ¹ , ZHOUYu ¹ ,  WENAi-qing ¹

1. Department of Blood Transfusion, Daping Hospital, Third Military Medical University, Chongqing 400042, China;
2. Department of Epidemiology, Faculty of Military Prevention Medicine, Third Military Medical University, Chongqing 400038, China;

Corresponding?author：

WENAi-qing, Email: dpyysxkwaq@hotmail.com

Keywords：

Chronic liver failure; Plasma exchange; Meta-analysis; Systematic review; Randomized controlled trial; Clinical controlled trial

DOI：

10.7507/1672-2531.20150111

Video：

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Objective To systematically review the efficacy and safety of plasma exchange (PE) versus routine medical therapy (RMT) for patients with chronic liver failure. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 7, 2014), CBM, CNKI, and VIP from inception to August 2014, to collect randomized controlled trials (RCTs) and clinical controlled trials (CCTs) of PE versus RMT for chronic liver failure patients. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 7 RCTs and 9 CCTs involving 1 632 patients (822 in the PE group and 810 in the RMT group) were included. The results of meta-analysis showed that:compared with the RMT group, the PE group had lower mortality rate (RCT:OR=0.24, 95%CI 0.13 to 0.43; CCT:OR=0.48, 95%CI 0.30 to 0.78) and higher total effective rate (RCT:OR=4.04, 95%CI 2.80 to 5.85; CCT:OR=3.45, 95%CI 2.11 to 5.64). Subgroup analysis based on the stage of liver failure showed that the PE group was superior to the RMT group in early- and intermediate-stage patients with liver failure in total effective rate (early stage:OR=4.78, 95%CI 1.87 to 12.23; intermediate stage:OR=4.43, 95%CI 1.77 to 11.08), but this difference was not found in advanced liver failure patients (OR=1.61, 95%CI 0.35 to 7.38). Seven studies reported 187 cases of adverse reactions (11.46%), and most of them were pruritus and urticaria. Conclusion Current evidence shows, compared with the routine medical therapy, the PE therapy could be effective to early- and intermediate-stage liver failure patients, but not be effective to advanced liver failure patients. In addition, patients who received the PE therapy have risks of adverse reactions which mainly are allergic reaction. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： CHENGZhi-ling, SUNGui-xiang, LINHui, LUYao, ZHOUYu, WENAi-qing. Efficacy and Safety of Plasma Exchange for Chronic Liver Failure: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 664-671. doi: 10.7507/1672-2531.20150111 Copy

1.	中華醫學會感染病學分會肝衰竭與人工肝學組,中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診療指南. 實用肝臟病雜志,2006,9(6) : 321-324.
2.	段鐘平. 人工肝臟治療學. 第1版. 北京: 中國醫藥科技出版社,2002: 42.
3.	張晶,段鐘平,何金秋. 人工肝治療對重型肝病患者生存期的影響. 中華肝臟病雜志,2006,14(9) : 321.
4.	Joseph S,Jeffrey LW,Anand P. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue. Journal of Clinical Apheresis,2013,7(28) : 145-284.
5.	陳澤鑫,劉慧,潘益峰,等. 試驗性和觀察性研究相關醫學文獻質量評價方法,中國循證醫學雜志,2011,11(11) : 1229-1236.
6.	張修禮. 血漿置換治療肝功能衰竭. 第二軍醫大學學報,2004,2(25) : 227-228.
7.	陳立宇,王文雅,等. 血漿置換對藥物性肝衰竭治療效果分析,藥品評價,2007,4(6) : 405-407.
8.	李武,段志文. 血漿置換對治療肝功能衰竭的療效觀察. 昆明醫學院學報,2008,(1) : 138-141.
9.	Yu JW,Sun LJ,Zhao YH,et al. Prediction value of model for end-stage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment. Hepatology,2008,26(23) : 1242-1249.
10.	寧軍. 高通量CRRT和血漿置換聯合應用治療藥物性肝衰竭療效分析. 慢性病學雜志,2010,9(12) : 1015-1016.
11.	Mao W,Ye B,Lin S,et al. Prediction value of model for end-stage liver disease scoring system on prognosis in the acute on chronic liver failure patients with plasma exchange treatment. Asaio J,2010,56(5) : 475-478.
12.	劉志紅,江建寧,羅光漢,等. 非生物型人工肝治療急性肝衰竭的臨床研究. 廣西醫科大學學報,2010,27(6) : 873-874.
13.	寧家輝,霍大浪,鄭在英. 人工肝血漿置換治療肝衰竭24例療效觀察. 山東醫藥,2010,50(9) : 78-79.
14.	胡偉躍,李進,駱紅霞,等. 血漿置換型人工肝聯合內科治療乙肝肝衰竭效果觀察. 中國現代醫生,2011,49(21) : 29-30.
15.	劉麗. 人工肝血漿置換治療肝衰竭50例臨床療效觀察. 淮海醫藥,2011,29(5) : 409-410.
16.	吳穗,楊紅潔. 肝衰竭患者血漿置換術治療的臨床觀察. 中國輸血雜志,2012,25(3) : 251-252.
17.	涂文輝,侯偉,金茜,等. 單純血漿置換術治療肝衰竭30例臨床分析. 中國現代醫生,2012,50(35) : 31-33.
18.	蔣良君,陽學風,吳清,等. 血漿置換在肝衰竭治療中的臨床應用體會. 中國現代醫藥雜志,2012,14(11) : 24-26.
19.	路秀萍. 人工肝血漿置換治療肝功能衰竭45例臨床療效觀察. 中國當代醫藥,2012,19(6) : 45-46.
20.	吳濤,蔣良君,陽學風,等. 血漿置換在肝衰竭治療中的臨床應用體會. 中國現代醫藥雜志,2012,14(11) : 24-26.
21.	馮夢蝶. 肝衰竭血漿置換聯合血液凈化治療臨床分析. 吉林醫藥,2012,7(33) : 1508.
22.	Nakae H,Yonekawa T,Narita K,et al. Are proinflammatory cytokine concentrations reduced by plasma exchange in patients with severe acute hepatic failure? . Res Commun Mol Pathol Pharmacol,2001,109(1-2) : 65-72.
23.	Sadahiro T,Hirasawa H,Oda S,et al. Usefulness of plasma exchange plus continuous hemodiafiltration to reduce adverse effects associated with plasma exchange in patients with acute liver failure . Crit Care Med,2001,29(7) : 1386-1392.
24.	Takahashi Y. Evaluation of the special therapies in fulminant viral hepatitis--a multi-institution study. Nihon Shokakibyo Gakkai Zasshi,1995,92(1) : 7-18.
25.	彭蕾,葉瑁,郜玉峰,等. 血漿置換對慢性重型肝炎的療效分析．中華臨床醫師雜志,2014,8(13) : 2416-2419.
26.	曾敬科,許飛,溫蕾,等. 人工肝血漿置換治療早中期肝衰竭的臨床觀察. 贛南醫學院學報,2014,34(1) : 60-61.
27.	人工肝支持系統治療指征、標準及技術指南. 中華傳染病雜志,2002,20(12) : 254-258.

1. 中華醫學會感染病學分會肝衰竭與人工肝學組,中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診療指南. 實用肝臟病雜志,2006,9(6) : 321-324.
2. 段鐘平. 人工肝臟治療學. 第1版. 北京: 中國醫藥科技出版社,2002: 42.
3. 張晶,段鐘平,何金秋. 人工肝治療對重型肝病患者生存期的影響. 中華肝臟病雜志,2006,14(9) : 321.
4. Joseph S,Jeffrey LW,Anand P. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue. Journal of Clinical Apheresis,2013,7(28) : 145-284.
5. 陳澤鑫,劉慧,潘益峰,等. 試驗性和觀察性研究相關醫學文獻質量評價方法,中國循證醫學雜志,2011,11(11) : 1229-1236.
6. 張修禮. 血漿置換治療肝功能衰竭. 第二軍醫大學學報,2004,2(25) : 227-228.
7. 陳立宇,王文雅,等. 血漿置換對藥物性肝衰竭治療效果分析,藥品評價,2007,4(6) : 405-407.
8. 李武,段志文. 血漿置換對治療肝功能衰竭的療效觀察. 昆明醫學院學報,2008,(1) : 138-141.
9. Yu JW,Sun LJ,Zhao YH,et al. Prediction value of model for end-stage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment. Hepatology,2008,26(23) : 1242-1249.
10. 寧軍. 高通量CRRT和血漿置換聯合應用治療藥物性肝衰竭療效分析. 慢性病學雜志,2010,9(12) : 1015-1016.
11. Mao W,Ye B,Lin S,et al. Prediction value of model for end-stage liver disease scoring system on prognosis in the acute on chronic liver failure patients with plasma exchange treatment. Asaio J,2010,56(5) : 475-478.
12. 劉志紅,江建寧,羅光漢,等. 非生物型人工肝治療急性肝衰竭的臨床研究. 廣西醫科大學學報,2010,27(6) : 873-874.
13. 寧家輝,霍大浪,鄭在英. 人工肝血漿置換治療肝衰竭24例療效觀察. 山東醫藥,2010,50(9) : 78-79.
14. 胡偉躍,李進,駱紅霞,等. 血漿置換型人工肝聯合內科治療乙肝肝衰竭效果觀察. 中國現代醫生,2011,49(21) : 29-30.
15. 劉麗. 人工肝血漿置換治療肝衰竭50例臨床療效觀察. 淮海醫藥,2011,29(5) : 409-410.
16. 吳穗,楊紅潔. 肝衰竭患者血漿置換術治療的臨床觀察. 中國輸血雜志,2012,25(3) : 251-252.
17. 涂文輝,侯偉,金茜,等. 單純血漿置換術治療肝衰竭30例臨床分析. 中國現代醫生,2012,50(35) : 31-33.
18. 蔣良君,陽學風,吳清,等. 血漿置換在肝衰竭治療中的臨床應用體會. 中國現代醫藥雜志,2012,14(11) : 24-26.
19. 路秀萍. 人工肝血漿置換治療肝功能衰竭45例臨床療效觀察. 中國當代醫藥,2012,19(6) : 45-46.
20. 吳濤,蔣良君,陽學風,等. 血漿置換在肝衰竭治療中的臨床應用體會. 中國現代醫藥雜志,2012,14(11) : 24-26.
21. 馮夢蝶. 肝衰竭血漿置換聯合血液凈化治療臨床分析. 吉林醫藥,2012,7(33) : 1508.
22. Nakae H,Yonekawa T,Narita K,et al. Are proinflammatory cytokine concentrations reduced by plasma exchange in patients with severe acute hepatic failure? . Res Commun Mol Pathol Pharmacol,2001,109(1-2) : 65-72.
23. Sadahiro T,Hirasawa H,Oda S,et al. Usefulness of plasma exchange plus continuous hemodiafiltration to reduce adverse effects associated with plasma exchange in patients with acute liver failure . Crit Care Med,2001,29(7) : 1386-1392.
24. Takahashi Y. Evaluation of the special therapies in fulminant viral hepatitis--a multi-institution study. Nihon Shokakibyo Gakkai Zasshi,1995,92(1) : 7-18.
25. 彭蕾,葉瑁,郜玉峰,等. 血漿置換對慢性重型肝炎的療效分析．中華臨床醫師雜志,2014,8(13) : 2416-2419.
26. 曾敬科,許飛,溫蕾,等. 人工肝血漿置換治療早中期肝衰竭的臨床觀察. 贛南醫學院學報,2014,34(1) : 60-61.
27. 人工肝支持系統治療指征、標準及技術指南. 中華傳染病雜志,2002,20(12) : 254-258.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Plasma Exchange for Chronic Liver Failure: A Meta-analysis

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