Abstract: Objective To investigate the clinical characteristics of patients with hepatitis B-induced acute-on-chronic liver failure（ACLF） and the effects of plasma exchanges（PE） on their prognosis. MethodsAccording to the guideline for diagnosis and treatment of liver failure,the clinical data of 52 patients with hepatitis B related ACLF were collected. The relationship between the laboratory indexes at admission and the prognosis of patients, and the effects of complications on the prognosis were analyzed. In addition,the laboratory indexes before and after PE were also explored to evaluate its efficacy. ResultsSerum levels of PT,APTT,INR and blood ammonia at admission in dead patients were significantly higher than those in survived cases[（48.8±11.7） s vs.（42.7±14.0） s,（65.8±19.0） s vs.（48.0±11.4） s,（2.4±1.0） vs.（1.7±0.4）,（100.1±74.7） μmol/L vs. （47.9±21.5） μmol/L,respectively,P<0.05 for all],while serum levels of PTA,PLT,ALB and potassium at admission in dead cases were significantly lower than those in survived cases [（31.8±12.9） % vs. （47.9±21.2）%, （85.6±61.3）×10⁹/L vs.（133.4±50.7）×10⁹/L,（29.2±4.1） g/L vs.（32.8±4.7） g/L,（3.8±0.5） μmol/L vs.（4.1±0.6） μmol/L,respectively,P<0.05 for all];the hepatic encephalopathy,ascites,spontaneous peritonitis,electrolyte disorder and more than one of them in dead patients were higher than in survived cases（37.5% vs. 2.8%, 68.7% vs. 30.3%,25.0% vs. 2.8%, 62.5% vs. 11.1%,62.5% vs. 11.1%, respectively,P<0.05 for all）;Lab indexes like PTA,WBC,ALB and Urea after the PE were significantly higher than those before treatment [（44.8±23.5） % vs. （36.6±14.6）%,（8.0±3.6）×10⁹/L vs. （5.9±2.8）×10⁹/L,（36.4±3.6） g/L vs. （33.7±4.1）g/L,（7.1±4.6） mmol/L vs. （5.4±3.8） mmol/L, respectively,P<0.05 for all];RBC,Hb,ALT,AST,TBIL and DBIL after the PE were remarkably lower than those before treatment [（3.9±0.7） ×10⁹/L vs. （4.2±0.8）×10⁹/L,（119.5±18.2） g/L vs. （130.6±23.8） g/L,（100.6±67.9） U/L vs. （300.0±302.3） U/L,（120.0±62.8） U/L vs. （227.2±174.6） U/L,（335.7±121.3） μmol/L vs. （410.8±129.8） μmol/L,（226.3±77.9） μmol/L vs. （290.4±100.5） μmol/L,respectively,P<0.05 for all）. Conclusion PT,PLT and ALB are sensitive laboratory indexes for the prediction of the prognosis in patients with hepatitis B related ACLF,and patients with complications have poor prognosis. PE could temporarily improve the blood coagulation function and the liver function,but has no influence on the survival in the patients with hepatitis B related ACLF.

Key words: Acute-on-chronic liver failure, Hepatitis B, Complications, Plasma exchanges, Prognosis