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.	中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊疗指南. 实用肝脏病杂志,2006,9(6) : 321-324.
2.	段钟平. 人工肝脏治疗学. 第1版. 北京: 中国医药科技出版社,2002: 42.
3.	张晶,段钟平,何金秋. 人工肝治疗对重型肝病患者生存期的影响. 中华肝脏病杂志,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.	陈泽鑫,刘慧,潘益峰,等. 试验性和观察性研究相关医学文献质量评价方法,中国循证医学杂志,2011,11(11) : 1229-1236.
6.	张修礼. 血浆置换治疗肝功能衰竭. 第二军医大学学报,2004,2(25) : 227-228.
7.	陈立宇,王文雅,等. 血浆置换对药物性肝衰竭治疗效果分析,药品评价,2007,4(6) : 405-407.
8.	李武,段志文. 血浆置换对治疗肝功能衰竭的疗效观察. 昆明医学院学报,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.	宁军. 高通量CRRT和血浆置换联合应用治疗药物性肝衰竭疗效分析. 慢性病学杂志,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.	刘志红,江建宁,罗光汉,等. 非生物型人工肝治疗急性肝衰竭的临床研究. 广西医科大学学报,2010,27(6) : 873-874.
13.	宁家辉,霍大浪,郑在英. 人工肝血浆置换治疗肝衰竭24例疗效观察. 山东医药,2010,50(9) : 78-79.
14.	胡伟跃,李进,骆红霞,等. 血浆置换型人工肝联合内科治疗乙肝肝衰竭效果观察. 中国现代医生,2011,49(21) : 29-30.
15.	刘丽. 人工肝血浆置换治疗肝衰竭50例临床疗效观察. 淮海医药,2011,29(5) : 409-410.
16.	吴穗,杨红洁. 肝衰竭患者血浆置换术治疗的临床观察. 中国输血杂志,2012,25(3) : 251-252.
17.	涂文辉,侯伟,金茜,等. 单纯血浆置换术治疗肝衰竭30例临床分析. 中国现代医生,2012,50(35) : 31-33.
18.	蒋良君,阳学风,吴清,等. 血浆置换在肝衰竭治疗中的临床应用体会. 中国现代医药杂志,2012,14(11) : 24-26.
19.	路秀萍. 人工肝血浆置换治疗肝功能衰竭45例临床疗效观察. 中国当代医药,2012,19(6) : 45-46.
20.	吴涛,蒋良君,阳学风,等. 血浆置换在肝衰竭治疗中的临床应用体会. 中国现代医药杂志,2012,14(11) : 24-26.
21.	冯梦蝶. 肝衰竭血浆置换联合血液净化治疗临床分析. 吉林医药,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,叶瑁,郜玉峰,等. 血浆置换对慢性重型肝炎的疗效分析．中华临床医师杂志,2014,8(13) : 2416-2419.
26.	曾敬科,许飞,温蕾,等. 人工肝血浆置换治疗早中期肝衰竭的临床观察. 赣南医学院学报,2014,34(1) : 60-61.
27.	人工肝支持系统治疗指征、标准及技术指南. 中华传染病杂志,2002,20(12) : 254-258.

1. 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊疗指南. 实用肝脏病杂志,2006,9(6) : 321-324.
2. 段钟平. 人工肝脏治疗学. 第1版. 北京: 中国医药科技出版社,2002: 42.
3. 张晶,段钟平,何金秋. 人工肝治疗对重型肝病患者生存期的影响. 中华肝脏病杂志,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. 陈泽鑫,刘慧,潘益峰,等. 试验性和观察性研究相关医学文献质量评价方法,中国循证医学杂志,2011,11(11) : 1229-1236.
6. 张修礼. 血浆置换治疗肝功能衰竭. 第二军医大学学报,2004,2(25) : 227-228.
7. 陈立宇,王文雅,等. 血浆置换对药物性肝衰竭治疗效果分析,药品评价,2007,4(6) : 405-407.
8. 李武,段志文. 血浆置换对治疗肝功能衰竭的疗效观察. 昆明医学院学报,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. 宁军. 高通量CRRT和血浆置换联合应用治疗药物性肝衰竭疗效分析. 慢性病学杂志,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. 刘志红,江建宁,罗光汉,等. 非生物型人工肝治疗急性肝衰竭的临床研究. 广西医科大学学报,2010,27(6) : 873-874.
13. 宁家辉,霍大浪,郑在英. 人工肝血浆置换治疗肝衰竭24例疗效观察. 山东医药,2010,50(9) : 78-79.
14. 胡伟跃,李进,骆红霞,等. 血浆置换型人工肝联合内科治疗乙肝肝衰竭效果观察. 中国现代医生,2011,49(21) : 29-30.
15. 刘丽. 人工肝血浆置换治疗肝衰竭50例临床疗效观察. 淮海医药,2011,29(5) : 409-410.
16. 吴穗,杨红洁. 肝衰竭患者血浆置换术治疗的临床观察. 中国输血杂志,2012,25(3) : 251-252.
17. 涂文辉,侯伟,金茜,等. 单纯血浆置换术治疗肝衰竭30例临床分析. 中国现代医生,2012,50(35) : 31-33.
18. 蒋良君,阳学风,吴清,等. 血浆置换在肝衰竭治疗中的临床应用体会. 中国现代医药杂志,2012,14(11) : 24-26.
19. 路秀萍. 人工肝血浆置换治疗肝功能衰竭45例临床疗效观察. 中国当代医药,2012,19(6) : 45-46.
20. 吴涛,蒋良君,阳学风,等. 血浆置换在肝衰竭治疗中的临床应用体会. 中国现代医药杂志,2012,14(11) : 24-26.
21. 冯梦蝶. 肝衰竭血浆置换联合血液净化治疗临床分析. 吉林医药,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,叶瑁,郜玉峰,等. 血浆置换对慢性重型肝炎的疗效分析．中华临床医师杂志,2014,8(13) : 2416-2419.
26. 曾敬科,许飞,温蕾,等. 人工肝血浆置换治疗早中期肝衰竭的临床观察. 赣南医学院学报,2014,34(1) : 60-61.
27. 人工肝支持系统治疗指征、标准及技术指南. 中华传染病杂志,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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