人工肝支持系统治疗急慢性肝功能衰竭的临床研究

Clinical Study on the Use of Artificial Liver Supporting System in the Treatment of Acute or Chronic Liver Failure

背景:目前肝功能衰竭尚缺乏有效的治疗方法,除非及时接受肝移植,否则患者要经受长时间的住院治疗,死亡率高。应用肝脏辅助支持系统治疗急、慢性肝功能衰竭在临床上已广泛开展。目的:对各种病因所致的肝功能衰竭患者应用血浆置换(PE)和分子吸附再循环系统(MARS)进行治疗,探讨两种非生物人工肝在急、慢性肝功能衰竭中的作用。方法:148例肝功能衰竭患者在常规内科治疗的基础上分为两个治疗组,PE组60例,MARS组88例。观察患者治疗前后肝肾功能、血氨、凝血机制、电解质、血常规等指标的变化,同时评价两个治疗组的临床转归和存活率。结果:经1～3个月的随访,PE和MARS组的存活率分别为55.0%和64.8%,MARS组存活率略优于PE组,但差异无统计学意义。PE和MARS治疗后肝功能指标明显改善,血氨显著降低,总蛋白、肾功能、电解质、血常规和血气分析指标无显著变化。治疗结束72h后复查凝血指标的变化,发现凝血酶原活动度显著升高,凝血酶原时间显著降低。PE组寒颤、胸闷气短、恶心呕吐等不良反应发生率较高,MARS组不良反应主要是恶心呕吐,发生率较低。结论:PE和MARS是治疗肝功能衰竭患者安全、有效的辅助方法,尤其对非病毒性终末期患者疗效更加显著。

Background： Currently, there is no effective treatment for hepatic failure, unless liver transplantation is performed timely. Otherwise, the patient needs long term hospitalization and the mortality will be still high. The auxiliary artificial liver support systems have already been used clinically in the treatment of acute and chronic liver failure. Aims： Use plasma exchange （PE） and molecular adsorbent recirculating system （MARS） to treat patients with liver failure caused by various diseases and to explore the effect of these two non-biological artificial liver supporting systems in the treatment of acute and chronic liver failure. Methods： On the basis of routine medical treatment, 148 patients with liver failure were divided into two groups, 60 patients were treated with PE and 88 patients were treated with MARS. Alterations in liver and renal function, blood ammonia, blood coagulating parameters, electrolytes and blood routine were observed before and after treatment, and the effects on clinical outcome and survival rate were evaluated. Results： After 1-3 months follow-up, the survival rates of these two groups were 55.0% and 64.8%, respectively. MARS was slightly better than PE, but the difference was not statistically significant. Both PE and MARS could decrease significantly the serum levels of total bilirubin, alanine aminotransferase, aspartate aminotransferase and ammonia. No obvious changes were observed in serum levels of total protein, renal function, electrolytes, blood routine and blood gas analysis. Prothrombin activity increased and prothrombin time decreased in both groups 72 hours after treatment. Adverse effect rate was higher in PE than in MARS group, such as tremor, short of breath, nausea and vomiting. Conclusions： Both PE and MARS are safe and effective auxiliary methods in the treatment of liver failure, especially for those liver failure patients caused by non-viral diseases.