混合型生物人工肝治疗中、晚期慢性重型肝炎的临床疗效观察

Observation on hybrid bioartificial liver support systems in treating chronic severe hepatitis：a study of 60 cases

目的观察三种混合型生物人工肝支持系统(HBLSS)治疗中、晚期慢性重型肝炎的临床效果。方法构建猪肝细胞中空纤维管型生物人工肝系统(BAL),构建三种组合方式的HBLSS：BAL与分子吸附再循环系统(MARS)组合；BAL与缓慢血浆置换(SPE)和持续血液透析滤过(CHDF)组合；BAL与缓慢血浆置换(SPE)和血液灌流(HP)组合。120例中、晚期慢性重型肝炎患者被随机均分为6组,治疗组分别接受BAL＋MARS(H1)、BAL＋SPE＋CHDF(H2)和BAL＋SPE＋HP(H3)治疗；对照组分别接受 MARS(C1)、SPE＋CHDF(C2)和SPE＋HP(C3)治疗。观察各组患者在治疗前、治疗结束时、治疗结束后72h的临床症状、肝性脑病、血清总胆红素、凝血酶原活动度、血清内毒素、血氨、肌酐和甲胎蛋白等的变化。观察各组的治愈好转率、不良反应的发生情况。结果治疗组与对照组均能改善患者临床症状、降低总胆红素、血海内毒素、血氨水平,提高凝血酶原活动度和甲胎蛋白水平,但以H1、H2、H3组作用明显。与H3组比较,H1、H2组能显著降低肌酐、血氨。H1、H2、H3、C1、C2、C3的治愈好转率分别为 65％(13／20)、60％(12／20)、45％(9／20)、45％(9／20)、40％(8／20)、20％(4／20)。H1、H2、H3治疗中均未发生严重不良反应。结论 H1、H2、H3组治疗中、晚期慢性重型肝炎的效果优于C1、C2、C3组,其中H2 组和H2组能明显改善肝肾功能,阻断多器官功能衰竭,疗效优于H3组。

Objective To study the clinical efficacy of three kinds of hybrid hioartificial liver support systems （HBLSS） in treating chronic severe hepatitis. Methods A bioartificial liver support system （BAL）, comprising porcine hepatocytes and fiber tube style hioreactor, was constructed. Then three kinds of HBLSS were constructed; Molecular absorbent recirculating system （MARS） plus BAL; slow plasma exchange （SPE） plus continuous hemodiafiltration （CHDF） and BAL; and SPE plus hemoperfusion （HP） and BAL. One hundred-twenty patients in middle or late stages of chronic severe hepatitis were enrolled in this study. They were randomly divided into 6 groups： H1 group was treated with BAL＋MARS, H2 with BAL＋SPE＋CHDF and H3 with BAL＋SPE＋HP （as treatment groups）; C1 group was treated with MARS, C2 with SPE＋CHDF and C3 with SPE＋HP （as control groups）. The changes in the clinical symptoms, in the hepatic encephalopathy stages, and in the serum total bilirubin （TBIL）, the serum albumin （ALB）, the prothrombin activities （PTA）, endotoxin, ammonia, creatinine and a-fetal protein （AFP） were all observed before the treatment, fight after it and 72 hours later. The improving and curing rates and the rates of side effect occurrences in each group were observed. Results In all 6 groups, the patients＇ clinical symptoms ameliorated; their TBIL, endotoxin and ammonia levels decreased （P 〈 0.05）, and their PTA and AFP levels lowered significantly （P 〈 0.05）. But in the H1. H2 and H3 groups they were more distinctive than in the control groups. In H1 and H2 groups ereatinine and ammonia levels were decreased more significantly than in the H3 group （P 〈 0.05）. The improving and curing rates of each group were 65 % （13/20）, 60% （12/20）, 45% （9/20）, 45% （9/20）, 40% （8/20） and 20% （4/20） respectively. No serious side effects were observed during the treatment. Conclusion In treating middle and late stage chronic severe hepatitis, the measures used in H1, H2 and H3 are better than those in C1, C2 and C3. Furthermore, H1 and H2 treatments can ameliorate hepatic and renal functions, prevent the development of multiple organ dysfunction syndrome, and are better than those used in H3.