分子吸附再循环系统在重型肝炎治疗中的应用

Application of molecular adsorbents recirculating system in patients with severe hepatitis

目的探讨和评价分子吸附再循环系统(MARS)在重型肝炎治疗中的疗效及其作用机制。方法应用MARS治疗重型肝炎16例作为治疗组,21例重型肝炎采用综合治疗作为对照组,两组年龄、性别及肝功能损害相匹配,分别观察两组病人的预后及单次MARS治疗前后病人的精神、食纳、肝性脑病、平均动脉压、重要生化指标及肿瘤坏死因子的变化。结果两组病人预后有明显差别,治疗组存活率62.5%(10/16),较对照组38%(8/21)明显提高,单次治疗前后肝性脑病均不同程度改善,平均动脉压上升,血清胆红素、肿瘤坏死因子及尿素氮明显下降。结论应用MARS治疗能明显提高重型肝炎病人的存活率,其作用机制主要为通过清除病人体内的有毒代谢产物包括胆红素、NO、肿瘤坏死因子及血氨等,从而减轻肝细胞的坏死,改善血流动力学,预防和治疗肝性脑病及肝肾综合征,是重型肝炎安全有效的治疗方法。

Objective To summarize and evaluate the therapeutic effect and mechanism of Molecular Adsorbents Recireulating System （MARS） in patients with severe hepatitis. Methods A total of 37 patients with severe hepatitis were divided into two groups, MARS treatment group （n = 16 ）, and control group （n = 21 ） were treated with general methods. The age sex and the liver function between two groups were matching. Their prognosis were observed and the levels of serum total bilirubin, nonconjugated bilirubin, tumor necrosis factor（TNF-α） and mean arterial pressure （MAP） were observed in patients during a single treatment with MARS. Results There were significant difference in prognosis and complications between two groups. In treatment group ten of 16 patients had been cure or improved, 4 died, the survival rate was 62.5 % （10/16）, while the survival rate was 38 % （8/21） in control group. The levels of serum total bilirubin,non-conjugated bilirubin and TNF-α were significantly decreased from （547 ± 187）μmol/L to （312 ± 118）μ mol/L （P 〈 0.05）; （379 ± 134） μmol/L to （185 ± 68） μmol/L（P 〈 0.05） and （76.58 ± 23.21 ） pg/ml to （22.87 ± 20.05） pg/ml （P〈 0.01） respectively. The MAP were increased from （9.73 ± 0.67 ） kPa [ （73 ± 5 ） mmHg] to （ 11.1 ± 0.80） kPa [ （ 83 ± 6） mmHg] （P 〈 0.05） in patients during a single treatment with MARS. Conclusion The MARS can effectively clear the toxic metabolites eg. serum total bilirubin,non-conjugated bilirubin and TNF-α ;increase the MAP, and then decrease the necrosis of hepatocytes,improve the bepatorenal syndrome and hepatic encephalopathy. It is a safe and effective treatment in patients with sever hepatitis.