双重血浆分子吸附系统治疗肝衰竭患者应用甲磺酸萘莫司他与肝素抗凝有效性与安全性比较研究*

doi:10.3969/j.issn.1672-5069.2023.06.019

实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (6): 843-846.doi: 10.3969/j.issn.1672-5069.2023.06.019

双重血浆分子吸附系统治疗肝衰竭患者应用甲磺酸萘莫司他与肝素抗凝有效性与安全性比较研究^*

王新月, 周莉, 董金玲, 陈煜

100069 北京市首都医科大学附属北京佑安医院肝病中心四科/肝衰竭与人工肝治疗研究北京市重点实验室

收稿日期:2023-06-16 出版日期:2023-11-10 发布日期:2023-11-20
通讯作者: 陈煜,E-mail: chybeyond1071@ccmu.edu.cn
作者简介:王新月,女,24岁,医学硕士。主要从事重型肝炎基础与临床研究。 E-mail: wxinyue12138@163.com
共同第一作者:周莉,女,45岁,主任医师。主要从事重症肝病/肝衰竭内科与人工肝治疗研究。E-mail:doctorzl@sina.com
基金资助:
^* 北京市高层次公共卫生技术人才建设基金资助项目(编号:学科带头人-01-12);北京市医院管理中心“登峰”计划专项经费资助项目(编号:DFL20221501);北京肝胆相照公益基金会人工肝专项基金资助项目 (编号:iGandanF-1082022-RGG055)

Anticoagulant efficacy and safety comparison of nafmostat mesylate and heparin during double plasma molecular absorption system treatment in patients with liver failure

Wang Xinyue, Zhou Li, Dong JinLing, et al

Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Diseases, You’an Hospital, Affiliated to Capital Medical University, Beijing 100069, China

Received:2023-06-16 Online:2023-11-10 Published:2023-11-20

摘要/Abstract

摘要： 目的比较双重血浆分子吸附系统(DPMAS)治疗肝衰竭患者应用甲磺酸萘莫司他(NM)与肝素(HP)抗凝的效果和安全性差异。方法 2022年4月～2023年3月首都医科大学附属北京佑安医院诊治的肝衰竭患者49例,在接受DPMAS治疗过程中,均分别交叉接受一次NM或HP抗凝,监测活化部分凝血活酶时间(APTT)和凝血酶原时间(PT),计算凝血酶原时间活动度(PTA)。结果在98例次DPMAS治疗过程中,97例次顺利完成治疗,1次HP组因抗凝不足发生严重堵管导致治疗中断;NM组抗凝良好率为75.5%,显著高于HP组的28.6%,抗凝过量率为2.0%,显著低于HP组的67.3%(P<0.05);治疗后,NM组PTA和APTT分别为20.5(13.8,38.0)%和83.3(55.9,138.8)s,与HP组【分别为19.5(14.6,31.5)%和400.0(303.3,400.0)s】比,差异显著(P<0.05);NM组血清TBIL、ALB和血小板计数分别为(279.7±99.5)μmol/L、(24.4±4.2)g/L和59.5(42.5, 119.0) ×10⁹/L,与HP组【分别为(271.7±98.1)μmol/L、23.3(21.4,26.6)g/L和83.8±65.9×10⁹/L】比,无统计学差异(P＞0.05);在治疗后24 h内,HP组出现颈内静脉置管处渗血1例,NM组出现跨膜压和静脉压短时间内上升或机器频繁发生凝血警报2例。结论在行DPMAS治疗过程中,应用NM抗凝效果较HP更佳,安全性更高,值得进一步探讨。

关键词: 肝衰竭, 双重血浆分子吸附系统, 甲磺酸萘莫司他, 肝素, 治疗

Abstract: Objective This clinical trial was conducted to compare the anticoagulant efficacy and safety of nafmostat mesylate (NM) and heparin (HP) during double plasma molecular absorption system (DPMAS) treatment in patients with liver failure (LF). Methods 49 consecutive patients with LF or hyperbilirubinemia were encountered in You'an Hospital affiliated to Capital Medical University between April 2022 and March 2023, and all underwent at least twice DPMAS treatment. During the procedure, the anticoagulation was crossed by NM or HP once. The prothrombin time activity (PTA) and activated partial thromboplastin time (APTT) were monitored. Results Out of the 98 DPMAS treatment, the procedure successfully completed in 97 (99.0%), only discontinued once because of plugged pipes induced by insufficient anticoagulation of HP; the satisfactory anticoagulation rate in NM-managed group was 75.5%, significantly higher than 28.6%, and the over anticoagulation rate was 2.0%, much lower than 67.3%(P<0.05)in HP-intervened group; after the procedure, the PTA and APTT in NM anticoagulant group were 20.5(13.8, 38.0)% and 83.3(55.9, 138.8)s, significantly different compared to [19.5(14.6, 31.5)% and 400.0(303.3, 400.0)s, P<0.05] in HP anticoagulant group; there were no significant differences as respect to serum bilirubin, albumin levels and platelet counts between the two groups [(279.7±99.5)μmol/L, (24.4±4.2)g/L and 59.5(42.5, 119.0) ×10⁹/L vs. (271.7±98.1)μmol/L, 23.3(21.4, 26.6)g/L and 83.8±65.9×10⁹/L, respectively, P＞0.05]; 24 hours after DPMAS, the puncture skin haemorrhage was found in one case in HP anticoagulant group, and transient increased transmembrane pressure, or venous pressure or coagulation alert by the machine occurred in two cases in NM anticoagulant group. Conclusion The extracorporeal local anticoagulation of NM during DPMAS in patients with LF is efficacious and safer, and warrants further clinical investigation.

Key words: Liver failure, Double plasma molecular absorption system, Nafmostat mesylate, Heparin, Therapy

王新月, 周莉, 董金玲, 陈煜. 双重血浆分子吸附系统治疗肝衰竭患者应用甲磺酸萘莫司他与肝素抗凝有效性与安全性比较研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 843-846.

Wang Xinyue, Zhou Li, Dong JinLing, et al. Anticoagulant efficacy and safety comparison of nafmostat mesylate and heparin during double plasma molecular absorption system treatment in patients with liver failure[J]. Journal of Practical Hepatology, 2023, 26(6): 843-846.

参考文献

[1] 陈煜, 段钟平, 韩涛, 等. 人工肝血液净化技术临床应用专家共识(2022年版). 临床肝胆病杂志, 2022, 38: 767-75.
[2] Oudemans-van Straaten HM, Wester JPJ, de Pont A, et al. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? Intensive Care Med, 2006,32(2):188-202.
[3] 野入英世,花房规男. 血液净化疗法手册.2版.北京:北京科学技术出版社; 2013:124-133.
[4] 孔明, 周莉, 陈煜, 等. 双重血浆分子吸附系统治疗过程中肝素抗凝效果的影响因素研究. 首都医科大学学报, 2021, 42: 647-652.
[5] 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.肝衰竭诊治指南(2018年版).实用肝脏病杂志,2019,22(2):164-171.
[6] 马元吉, 陈芳, 许艳, 等. 局部枸橼酸抗凝在血浆吸附联合血浆置换治疗高危出血倾向肝衰竭患者中的应用. 世界华人消化杂志, 2018, 26: 165-173.
[7] 潘业, 欧宏杰, 曾建勇, 等. 血浆置换术中普通肝素及低分子肝素钠的应用分析. 中国医学工程, 2015, 23: 96-97.
[8] 周芸. 无肝素人工肝血浆置换术治疗肝功能衰竭的临床观察及护理. 实用临床医药杂志, 2017, 21(8): 46-48.
[9] Mulloy B, Hogwood J, Gray E, et al. Pharmacology of heparin and related drugs. Pharmacol Rev, 2016,68(1):76-141.
[10] 张红玉, 崔慧斐. 肝素药理作用和药物制剂的研究新进展. 中国药学杂志, 2019,54(22):1831-1839.
[11] Syed S, Reilly RF. Heparin-induced thrombocytopenia: a renal perspective. Nat Rev Nephrol, 2009,5(9):501-511.
[12] Lim JY, Kim JB, Choo SJ, et al. Anticoagulation during extracorporeal membrane oxygenation; Nafamostat mesilate versus heparin. Ann Thorac Surg, 2016,102(2):534-539.
[13] 刘志艳, 向倩, 崔一民. 甲磺酸萘莫司他临床应用的研究现状. 中国临床药理学杂志, 2020,36(15):2368-2372.
[14] Hitomi Y, Ikari N, Fujii S. Inhibitory effect of a new synthetic protease inhibitor (FUT-175) on the coagulation system. Haemostasis, 1985,15(3):164-168.
[15] Fuse I, Higuchi W, Toba K, et al. Inhibitory mechanism of human platelet aggregation by nafamostat mesilate. Platelets, 1999,10(4):212-218.
[16] Hwang SD, Hyun YK, Moon SJ, et al. Nafamostat mesilate for anticoagulation in continuous renal replacement therapy. Int J Artif Organs, 2013,36(3):208-216.
[17] Makino S, Egi M, Kita H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy. Int J Artif Organs, 2016,39(1):16-21.

双重血浆分子吸附系统治疗肝衰竭患者应用甲磺酸萘莫司他与肝素抗凝有效性与安全性比较研究^*

Anticoagulant efficacy and safety comparison of nafmostat mesylate and heparin during double plasma molecular absorption system treatment in patients with liver failure

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