新型人工肝——单向白蛋白透析滤过治疗肝功能衰竭的临床研究

Clinical study of a new type of artificial liver support—Single-pass albumin diafiltration in treatment of liver failure

目的:应用新型人工肝——单向白蛋白透析滤过(SPADF)治疗肝功能衰竭患者,研究其疗效和机制.方法:应用SPADF治疗26例肝功能衰竭患者.治疗过程中观察患者病情变化并比较治疗前后多种体液指标的变化.结果:26例肝衰竭患者一共经过34例次SPADF,治疗后临床症状及体征明显改善,特别是肝性脑病明显好转.血清胆红素、丙氨酸氨基转移酶、血氨、血肌酐、尿素氮、IL-1,IL-6,TNF-α水平显著降低(P<0.05),凝血酶原活动度和胆碱酯酶水平升高(P<0.05),血糖、血常规等在治疗前后均无明显变化.26例肝功能衰竭患者12例痊愈出院,4例接受肝移植,总体存活率61%.结论:新型人工肝SPADF是治疗肝功能衰竭的有效、安全手段,且操作简单,值得进一步研究和推广.

AIM： To study the curative effect of single-pass albumin diafihration （SPADF）, a new type of artificial liver support system, in the treatment of liver failure patients. METHODS： Twenty-six patients with liver failure were enrolled and treated intermittently 34 times with SPADF. Parameters in the blood were detected and compared before and after treatment. RESULTS： There were remarkable improvements in clinical symptoms and physical signs, especially in hepatic encephalopathy. The prothrombin activity （PTA） and cholinesterase （CHE） increased significantly （ P 〈 0. 05 ） and the serum blood urea nitrogen （BUN）, serum creatinine （SCr） , total bilirubin （TB） , total bile acid （TBA）, serum ammonia （NH3）, interleukin-1 （ IL-1 ）, interleukin-6 （ IL-6 ） , alanine aminotransferase （ALT） and tumor necrosis faetor-α （TNF-α） decreased obviously （P 〈 0.05 ）. Twelve patients were discharged from the hospital and 4 patients were bridged successfully to liver transplantation. The overall survival rate of SPADF treatment was 61%. CONCLUSION： Single-pass albumin diafihration is a safe, simple, convenient and effective therapeutic method for liver failure patients, which merits further study and wide application.