摘要
目的通过重型肝炎患者经人工肝支持系统(ALSS)之血浆置换(PE)和血浆灌流(PA)[1]交替联合治疗前后肝功能的变化,探讨人工肝支持系统之PE+PA联合治疗重型肝炎的作用机制,从代谢水平、分子水平为重型肝炎的治疗探寻重要依据。方法应用血浆置换和血浆灌流交替联合治疗本院重型肝炎46例,检测ALSS治疗前后及四周后患者肝功能指标:谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰基转移酶(GGT)、胆碱脂酶(CHE)、腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、前白蛋白(PA)、白蛋白(ALB)、总胆固醇(CHOL)、总胆汁酸(TBA)、总胆红素(TB)、直接胆红素(DB)、凝血酶原活动度(PTA)。结果ALSS之PE+PA联合治疗前后重型肝炎患者肝功能项目中:ALT、AST、ALP、GGT、ADA、LDH、TBA、明显下降(P〈0.05),TB、DB显著下降(P〈0.01),PA、CHE、CHOL明显升高(P〈0.05),PTA明显延长(P〈0.05),ALB无明显变化。四周后ALT、AST、ALP、GGT、ADA、LDH、TBA、TB、DB显著下降(P〈0.01),ALB明显升高P〈0.05),PA、CHE、CHOL显著升高(P〈0.01),PTA显著延长(P〈0.01)。结论重型肝炎经过ALSS之PE+PA联合治疗后,其肝功能指标明显改善,尤其是胆红素对机体有毒性的物质得到了大量的清除,同时补充了血浆蛋白、凝血因子等,明显改善了肝细胞的生理环境。因此,ALSS之PE+PA联合治疗是临床上治疗重型肝炎的安全、有效的措施,其主要机理为清除毒性物质,补充生物活性物质,为肝细胞的修复及再生创造良好的环境,较好地恢复了肝脏的各种功能,为进行临床治疗赢得了宝贵的时间,帮助患者渡过危险期,提高早期、中期重型肝炎的抢救成功率。
Objective Through liver function change of heavy hepatitis via combined alternation treatment with plasm exchange(PE)and plasm affusement (PA) by artificial liver support system(ALSS),discuss mechanism of PE+PA combined treatment of ALSS, and find the clew to cure heavy hepatitis at metabolic and molecular level. Method measure parameter change of liver function of 46 patients with heavy hepatitis in our hospital via ALSS treatment: ALT、AST、ALP、GGT、CHE、ADA、LDH 、PA、ALB、CHOL、TBA、TB、DB、PTA。Result ALT、AST 、ALP、GGT、ADA、LDH、TBA had fallen (p<0.05), TB、DB had markedly fallen (p<0.01), PA 、CHE、CHOL had rose(P〈0.05), PTA had extended(P〈0.05),ALB had no change via PE+PA combined treatment of ALSS. But 4 weeks later, ALT、AST 、ALP、GGT、ADA、LDH、TBA、TB、DB had markedly fallen down(P〈0.01), ALB had rose(P〈0.05), PA、CHE、CHOL had markedly rose(P〈0.01), PTA had markedly extended(P〈0.01). Conclusion After PE+PA combined treatment of ALSS, the parameter of liver function of heavy hepatitis has markedly improved, bilirubin had been cleaned out , plasm protein and thrombin factor had been furnished, so physiological environment has markedly been improved. So, PE+PA combined treatment of ALSS is a safe and effective method to cure heavy hepatitis. The mechanism is cleaning toxic matter out , furnishing bioactivator and Creating favorable environment to repair liver cell and regenerate it, which can restore liver function and won valued time for clinic treatment. It also can help patient endure crisis and enhance success rate to salvage patient with prophase or metaphase heavy hepatitis.
关键词
人工肝
重型肝炎
肝功能
Artificial Liver Heavy Hepatitis liver function
