[The effect of plasma exchange on immune function in patients with hyperbilirubinemia at different severity levels following liver cancer surgery].
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Objective To analyze the effect of plasma exchange on immune function in patients with hyperbilirubinemia of different severity after liver cancer surgery. Methods A total of 100 patients diagnosed with hyperbilirubinemia following liver cancer resection at Ganzhou People's Hospital from January 1, 2021 to December 31, 2024 were enrolled as the study participants. Using a random number table, they were assigned to either a control group (conventional drug therapy, n=50) or an observation group (conventional drug therapy+plasma exchange therapy, n=50). All patients were further categorized by hyperbilirubinemia severity as mild, moderate, or severe. The distribution within the control group was 12 (mild), 25 (moderate), and 13 (severe); the distribution within the observation group was 14 (mild), 24 (moderate), and 12 (severe). Fasting venous blood samples were collected from all participants to assess immune function and other indicators. Generalized estimating equation (GEE) models were used to analyze the differences in immune function indicators across different severity levels and between the two groups before and after treatment, as well as the interactive effects of time point, group, and disease severity on the relevant scores. Results Compared with the pre-treatment levles, the immune, liver, and coagulation function indicators in both groups were significantly improved after treatment. Before treatment, as hyperbilirubinemia severity increased from mild to severe, levels of immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), the Child-Pugh score for liver function, and the albumin-bilirubin (ALBI) score showed an upward trend, while the CD4+/CD8+ ratio showed a downward trend in both groups. After treatment, this trend persisted in both the control group and the observation group. Post-treatment comparisons between patients of the same severity level in the two groups showed that the observation group had significantly lower IgA, IgG, IgM, Child-Pugh, and ALBI score, and a significantly higher CD4+/CD8+ ratio than the control group. Furthermore, the magnitude of improvement in coagulation, liver, and immune function indicators was significantly greater in the observation group across all severity levels. The total clinical effectiveness rate was significantly higher in the observation group. GEE analysis showed that the levels of IgA, IgG, and IgM were significantly increased, while the CD4+/CD8+ ratio was significantly decreased with the increase in the severity of hyperbilirubinemia. The levels of IgA, IgG, and IgM were significantly decreased and the CD4+/CD8+ ratio was significantly increased after treatment. The decline in IgA, IgG, and IgM levels in the observation group was greater than that in the control group, and the increase in the CD4+/CD8+ ratio was also greater. The observation group demonstrated superior improvement in Child-Pugh and ALBI scores for patients with mild, moderate, and severe disease after treatment compared to the control group. Conclusion Plasma exchange therapy can effectively improve the immune, liver, and coagulation functions of patients with hyperbilirubinemia of different severity levels following liver cancer surgery, thereby offering significant clinical benefits.