人工肝支持系统治疗重型肝炎的疗效评价

Evaluation of the therapeutic effect of artificial liver support system on severe viral hepatitis

目的 探讨应用人工肝支持系统 (ALSS)治疗重型肝炎肝衰竭合并肝性脑病 ,研究其机制及评价疗效。方法 治疗组 2 6例重型肝炎 (重肝 )患者 ,其中急性、亚急性重肝 14例 ,慢性重肝 9例 ,酒精性重肝 2例 ,钩体病黄疸型重肝 1例。在综合护肝治疗基础上同时给予ALSS治疗。对照组 2 9例重肝患者 ,急性、亚急性重肝 8例 ,慢性重肝 2 1例 (其中肝性脑病 5例 ) ,仅给予综合护肝治疗。结果 治疗组急性、亚急性重肝治愈好转率为 71 4 % ,对照组为 2 5 0 % ;治疗组慢性重肝治愈好转率为5 5 6 % ,对照组为 9 5 2 %。两组差异有显著性 (P <0 0 1)。ALSS降低了重型肝炎的病死率。治疗组中 3例进行肝移植 ,2例存活 ,其中l例反复肝性脑病患者经 2O次ALSS治疗后 ,成功地进行了肝移植并存活 (3例肝移植患者均是在中山医科大学第一附属医院所做 )。结论 ALSS为重型肝炎的治疗提供了较为安全、有效的手段 ,ALSS对重型肝炎肝衰竭的早期、中期疗效较好 ,也为肝移植的开展提供了条件。

Objective To investigate the therapeutic effect of artificial liver support system(ALSS)on severe viral hepatitis with liver function failure and hepatic encephalopathy and to evaluate the relationship between its mechanism and therapeutic effect.?Methods The patients in the present study were allocated either into a treatment group or a control group.The treatment group consisted of 26 patients with severe viral hepatitis,with 14 each suffering from acute and subacute severs viral hepatitis,9 suffering from chronic severe viral hepatitis,two patients of alcoholism severe viral hepatitis,and one patient of the letosphrosis icterohemorrhagic severe hepatitis.The patients received a combined hepatotheragy with ALSS.The control group consisted of 29 patients severe viral hepatitis,of 8 patients are in the group of acute and subacute severe viral hepatitis.and 21 patients in the group of chronic severe viral hepatitis.The patients received a combined hepatotheragy.Results In the treatment group the cure and improvement rate in the group of acute and subacute severe viral hepatitis is up to 71.4%,but that in the control group is 25.0%.The cure and improvement rate in the treatment group of chronic severe viral hepatitis is 55.6%,and that in the control group is 9.52%.There is marked difference between the groups(P<0.01) and it is worth attempting so as to reduce the mortality of severe viral hepatitis.Conclusions ALSS is an effective and safe means to treat severe viral hepatitis,especially in early and middle stages,and it may be an useful support for liver transplantation.