MARS人工肝在急性肝衰竭治疗中的临床应用研究

Effect of Molecular Adsorbent Recycling System(MARS) Treating Acute Hepatic Failure

目的:评价MARS(molecularadsorbentrecyclingsystem,MARS)人工肝治疗肝衰竭的疗效.方法:对37例肝衰竭病人进行MARS治疗,检测治疗前后各种有毒物质及凝血因子的改变并进行比较.结果:①37例肝衰竭病人,经MARS治疗后,血总胆红素、总胆汁酸、肌酐、尿素氮、血氨、内毒素水平明显降低(P<0·05);血清NO和TNF-α、IL-4、IL-6水平明显降低(P<0·05);②单次的MARS人工肝治疗前后凝血因子IX(F·IX)及凝血因子X(F·X)无显著性改变(P>0·05),然而在连续的MARS治疗过程中,在连续两次MARS治疗前之间比较,F·IX以及F·X有显著性差异(P<0·05),即凝血因子呈上升趋势;③25例重型乙肝肝衰竭患者存活15例,存活率60·0%;5例肝脏移植术前急性肝衰竭患者均成功接受肝脏移植;5例肝脏移植术后急性肝衰竭患者存活2例,存活率40·0%.结论:①MARS通过全面清除肝衰竭毒素、NO和细胞因子,对肝衰竭有肯定的治疗作用;②MARS治疗可改善肝脏合成功能;③F·IX和F·X对肝衰竭预后的早期评估有重要意义;④MARS对于等待肝脏移植的肝衰竭患者,则发挥过渡性桥梁作用.

Objective: To evaluate the effect of MARS treating acute hepatic failure. Methods: 37 hepatic failure patients were treated with MARS, changed data in blood were collected before and after every treatment, these laboratory parameters before and after treatment were compared with each other. Results: (1) MARS treatment significantly decreased the total bilirubin, total bile acid, creatinine, urea nitrogen, ammonia and endotoxin levels (P<0.05), as well as the serum NO, TNF-α,IL-4 and IL-6 levels (P<0.05); (2) NO significant changes of coagulation factor IX (F.IX) and coagulation factor X (F.X) levels were found before and after every single MARS treatment (P>0.05), however during a serial of MARS treatment, the levels of F.IX and F.X before the latter MARS treatment were higher than the levels before the former MARS treatment (P<0.05). The levels of F.IX and F.X increased during MARS treatment. (3) The survival rate in 24 hepatic failure patients of severe hepatitis B was 60.0%(15/25); 5 patients with preoperative hepatic failure were successfully performed live transplantation: the survival rate in 5 postoperative hepatic failure patients undergone liver transplantation was 40.0%(2/5). Conclusions: (1) We may confirm the positive therapeutic impact of MARS in hepatic failure patients, and the effectiveness of MARS is correlated with overall removing of elevated levels of toxins, NO and cytokines. (2) MARS treatment can improve hepatic synthetic function. (3) F.IX and F.X have an important value in early evaluation of the prognosis of hepatic failure patients. (4) MARS acts as a bridge to the hepatic failure patients who are waiting for liver transplantation.