混合型生物人工肝治疗重型肝炎的初步研究

Preliminary study of hybrid bioartifidal liver in patients with severe hepatitis and hepatic failure

目的 观察混合型生物人工肝对重型肝炎的治疗效果并了解其安全性。方法 在综合治疗基础上采用由血浆置换、血浆吸附/血液灌流、连续性肾脏替代疗法与猪肝细胞中空纤维管型生物人工肝构成的混合型人工肝支持系统对20例重型病毒性肝炎进行56次支持治疗,设同期住院病情相似的20例患者作对照组,仅用综合治疗方法。结果 20例患者中均有显著疗效,中毒症状明显好转,血清总胆红素明显下降,凝血酶原活动度升高,内毒素明显下降,血氨明显下降。最终5例临床治愈出院,10例好转出院,1例接受肝移植,2例病情一度好转,自动出院,2例病情恶化死亡或自动出院。治愈好转率75％,有效率90％,不良反应少。对照组4例临床治愈,2例好转,14例死亡,治愈好转率35％,两组比较有显著差异。结论 混合型人工肝支持系统对重型病毒性肝炎肝功能衰竭患者有显著的支持治疗作用,耐受性良好,能明显提高重型肝炎的治愈好转率。

Objective To observe the clinical effects and safety of hybrid bioartificial liver (HBL)in patients with severe hepatitis.Methods 20 patients suffering from severe hepatitis were treated with hybrid bioartificial Liver (HBL) consisting of PE(plasma exchange) HP(hemoperfusion) XRRT and porcine hepatocyte - based bioartificial respectively.Other 20 cases with similar condition were compared as control.All of them were under standard therapeutic procedure.Results The 20 patients undergiong the treatment of HBL showed significant inprovements in clinical signs and symptoms,total serum bilirubin( TBIL); endotoxin,prothrombin activity (PAT) and ammonia.After the treatment,5 patients were discharged for spontaneous recovery and 10 for improvement,1 patient bridged for liver transplantation,another 2 patients recovered and the other 2 patients died or get worse.The control group 4 patients were discharged for spontaneous recovery and 2 for improvement,2 patients died.The survival rate is 75% and 35% in the control group.(P < 0.01) The effective rate in HBL gronp is 90% .Conclusion HBL can be a safe and beneficial treatment for patients with severe hepatitis and hepatic failure.HBL was well tolerated with evidence of clinical improvement and mild side effects.