混合型生物人工肝对阻断发展成多器官功能障碍综合征的作用

The clinical research of hybrid bioartificial liver for blocking the SIRS to MODS stage in patients with fulminant liver failure

目的 通过混合型生物人工肝治疗对急性或亚急性肝炎肝功能衰竭患者血清促炎性细胞因子和内毒素的清除作用 ,探讨其减轻全身炎症反应综合征 (SIRS)的程度并降低多器官功能障碍综合征(MODS)发生的效果。方法 组合型生物人工肝由血浆置换和猪肝细胞型生物人工肝构成。 5例重症肝炎肝功能衰竭患者 (急性重型 3例和亚急性重型 2例 )各行组合型生物人工肝治疗 1次 ,时间约 10～ 12h ,于治疗前、治疗中、治疗后分 3个不同时段取血分别测肝功能、肾功能、血氨、血清TNF -α、IL 6及内毒素水平 ,并监测血液动力学指标和神经系统症状。结果 3例治疗前伴肝性脑病患者昏迷程度减轻。与治疗前比较 ,血清总胆红素 (TBIL)、TNF -α、IL 6及血清内毒素水平明显降低 (P<0 0 1) ,胆碱脂酶 (CHE)、凝血酶原活动度显著升高 (P <0 0 1)。治疗前合并 2种器官衰竭者 4例 ,3种器官衰竭者 1例。治疗后未再继续发展。其中 2例患者痊愈 (2种器官衰竭 ) ,1例 1周后成功实施肝移植 (3种器官衰竭 ) ,其余 2例分别存活 8日和 2 1日 ,治疗后有效为 4 5 ,存活为 3 5。结论 混合型生物人工肝能明显的降低重症肝炎急性期血清促炎性细胞因子和内毒素的水平 ,是遏制从SIRS到MODS病理发展、促进衰竭脏器恢复的有效手段。

Objective To study the role of hybrid bioartificial liver(HBL) on clearing proinflammatory cytokines and endotoxin from patients with acute and sub-acute liver failure and the effects of SIRS and MODS.Methods HBL consisted of plasma exchange and porcine hepatocyte-based bioartificial liver.5 cases with severe liver failure(3 acute and 2 subacute) were treated with HBL.The clinical signs and symptoms,total bilirubin(TBIL),serum ammonia,endotoxin and prothrombin activity(PTA),cholinesterase (CHE) were recorded pre,during and post treatment.Results 2 patients recovered spontaneously recovery and 1 patient bridged for OLT successfully,another 2 patients died On the 8 th day and 21 st day.The survival and effective rate were 3/5 and 4/5 respectively.3 patients with hepatic coma improved in the level of encephalopathy.All patientss PTA and CHE were increased significantly (P<0 01),while the serum TBIL,endotoxin,TNF-α,IL 6 were decreased.Conclusion The proinflammatory cytokines(TNF-α,IL 6 and endotoxin)were significantly removed by HBL which appeared to be effective to block the SIRS to MODS stage in patients with acute and sub-acute liver failure. [