Objective To observe the clinical effect of plasma exchange（PE），double plasma molecular adsorption system（DPMAS）and molecular adsorption recycling system（MARS）in the treatment of acute-onchronic liver failure，and to find the best way for the treatment of liver failure. Methods From January 2017 to December 2018，66 patients with acute-on-chronic liver failure who underwent liver transplantation in our hospital were analyzed retrospectively. According to different treatment methods，they were divided into PE group（23 cases）， DPMAS group（23 cases）and MARS group（20 cases）. The clinical data of all patients before and after treatment were collected and analyzed. Results The effective rate of MARS group was 90.0%，higher than that of PE group and DPMAS group（52.2% and 56.5%）. The difference was statistically significant（P ＜ 0.05）. There were significant differences in white blood cell，hemoglobin and platelet counts between the three groups before and after treatment （P ＜ 0.05）. In PE group，international normalized ratio（INR）and prothrombin activity（PTA）were significantly improved after treatment（P ＜ 0.05）. The liver function indexes of the three groups were improved after treatment， and MARS group was the most obvious（P ＜ 0.05）. Conclusion There are advantages and disadvantages in the three kinds of artificial liver treatment modes，of which MARS is the best one. The treatment mode should be selected reasonably according to the patients' condition in clinical work.

目的 观察血浆置换（plasma exchange，PE）、双重血浆分子吸附系统（double plasma molecular absorption system，DPMAS）、分子吸附再循环系统（molecular absorbent recycling system，MARS） 治疗慢加急性肝衰竭晚期患者的临床疗效，为治疗肝衰竭寻找最佳模式。方法 回顾性分析 2017 年 1 月— 2018 年 12 月间在天津市第一中心医院拟行肝移植术的 66 例慢加急性肝衰竭晚期患者资料，按治疗方法 不同分为 PE 组 23 例，DPMAS 组 23 例，MARS 组 20 例。收集所有患者治疗前后临床资料并对比分析。 结果 MARS 组治疗有效率为 90.0%，高于 PE 组和 DPMAS 组（52.2% 和 56.5%），差异有统计学意义 （P ＜ 0.05）。3 组患者治疗前后对白细胞计数、血红蛋白、血小板均有影响，差异有统计学意义（P ＜ 0.05）。 PE 组患者治疗后能明显改善国际标准化比值与凝血酶原活动度，差异有统计学意义（P ＜ 0.05）。3 组患者 治疗前后肝功能指标均有改善，以 MARS 组改善最明显，差异有统计学意义（P ＜ 0.05）。结论 3 种人工 肝治疗模式均存在其优缺点，其中以 MARS 治疗效果最佳，临床工作中应根据患者病情合理选择治疗模式。