应用分子吸附循环系统治疗急性肝功能衰竭的经验

Molecular adsorbent recycling system for acute liver failure patients

目的探讨急性肝功能衰竭患者等待肝移植期间应用分子吸附循环系统的治疗效果。方法本组共有16例急性肝功能衰竭患者在等待肝移植期间接受了分子吸附循环系统治疗。结果16例患者经治疗临床症状及体征明显改善：凝血酶原时间、总胆汁酸、丙氨酸转氨酶、天冬氨酸转氨酶、肌酐和血氨水平明显降低（P〈0．05）；肿瘤坏死因子α、-氧化氮和白细胞介素10等细胞因子水平有所下降，但无统计学意义（P〉0．05）；序贯性脏器衰竭评估的计分由9．91±1．09降至6．64±1．76，Glascow昏迷评分由7．29±2．06升至13．26±2．14。16例患者中14例成功过渡到肝移植治疗，13例痊愈出院。治疗成功率为81．25％。结论分子吸附循环系统是治疗肝功能衰竭安全而有效的辅助方法，帮助急性肝功能衰竭患者顺利渡过肝移植等待期。

Objective To study molecular adsorbent recycling system（MARS） in the treatment of patients with acute liver failure waiting for liver transplantation. Methods The effects of MARS artificial liver treatments in 16 cases were reviewed. Results There was a remarkable improvement in clinical symptoms and physical signs after MARS treatment, including significant decrease in prothrombin time, total bile acid, level of alanine aminotransferase, aspartate aminotransferase, creatinine, and blood ammonia （P 〈 0. 05） ; There was no statistical change in NO,TNF-α and IL-10 （P 〉 0. 05 ）. Sequential organ failure assessment （SOFA） score decreased from 9. 91 ± 1.09 to 6. 64 ± 1.76 and Glascow coma score increased from 7. 29 ±2.06 to 13.26 ±2. 14. Fourteen patients were tided over to liver transplantation among them 13 patients survived and were successfully discharged from the hospital. The survival rate was 89. 5%. Conclusion MARS is a safe and effective assistant device in bridging acute liver failure patients to liver transplantation.