人工肝治疗对重型肝病患者生存期的影响

Survival analysis on liver failure patients treated with an artificial liver support system

目的通过前瞻性、多中心、大样本的对照研究,探讨人工肝治疗对重型肝病患者生存期的影响。方法前瞻性地选择首都医科大学附属北京佑安医院等5家医院的重型肝炎和慢性肝炎重度(且凝血酶原活动度<50％)患者518例,将患者分为人工肝治疗组和常规内科治疗对照组,记录其诊断、分期等原始资料并进行随访,采用Kaplain-Maier方法进行生存情况分析。结果急性重型肝炎患者人工肝治疗组的中位生存期为(8．0±0．4)d,内科治疗对照组为(4．0±0．2)d,P=0．004。人工肝治疗2次以上疗效更加明显,它可使慢眭重型肝炎患者生存期由(27．0±1．6)d延长至(39．0±4．0)d,重型肝炎中期患者生存期由(38．0±17．5)d延长至(66．0±18．6)d;晚期患者生存期由(18．0±4．0)d延长至(26．0±2．5)d,差异均有统计学意义。结论人工肝治疗能够延长急性重型肝炎患者、慢性及亚急性重型肝炎中晚期患者的生存时间,多次治疗效果显著优于单次治疗和内科治疗。

Objective To evaluate the efficacy of artificial liver support system （ALSS） in the treatment of liver failure patients. Methods This is a prospective, multi-center, controlled, large sample clinic trial. 518 patients with liver failure from 5 hospitals were studied and followed. All the patients received similar pharmacological manipulation according to one and the same protocol but were divided into an ALSS treatment group and a control group without ALSS treatment. The ALSS treatment proce- dures included plasma exchange, molecular adsorbent recirculating system （MARS）, plasma exchange plus hemofiltration and other combined nonbioartificial methods. The analysis of survival time was computed using the Kaplain-Maier method, and comparison among groups was done using Log-Rank, Breslow and/or the Tarone-Ware test. Results Survival time of acute liver failure patients was prolonged from 4.0 ± 0.2 days to 8.0 ± 0.4 days （P = 0.004）. ALSS was shown to be two times more effective. ALSS increased the survival time of acute on chronic （A on C） liver failure patients from 27.0 ± 1.6 days to 39.0 ± 4.0 days （P 〈 0.01）. In addition, it increased the survival time of the patients in the middle and end stage of subacute liver failure and A on C liver failure, but had no significant effects on early stage patients. The survival time of middle stage patients was 38.0 ± 17.5 days in the control group vs 66.0 ± 18.6 days in the ALSS group （P 〈 0.05）. The survival time of end stage patients of the control group and the ALSS group was 18.0 ± 4.0 days vs 26.0 ± 2.5 days （ P 〈 0.01）. Conclusions Multi ALSS treatment is more effective than the standard medicinal liver care treatment. Multi-ALSS treatment could increase survival time of patients suffering from acute liver failure or A on C liver failure, especially in their middle and end stages. It is important and necessary to treat these patients with ALSS.