肝衰竭人工肝治疗的个体化选择

Clinical selection of individualizd artificial liver support

肝衰竭以肝性脑病、黄疸、凝血功能低下和高病死率为特征.人工肝支持旨在暂时替代肝脏功能,等待肝脏功能恢复或肝移植.个体化的人工肝支持应兼顾如下方面：清除蛋白结合毒素和/或水溶性毒素,清除细胞因子等炎性介质,纠正低凝血症,以期进行代谢支持和免疫调控;促进肝细胞再生,逆转可能导致患者死亡的多脏器衰竭.传统的非生物型人工肝均不能满足个体化治疗的需求,新近出现的白蛋白透析、成分血浆分离吸附和血浆滤过透析等杂合血液净化模式则为肝衰竭人工肝个体化治疗带来了更多、更好的选择.基于肝衰竭的病理生理学和器官功能障碍特点,作者提出人工肝个体化线路图供临床治疗时选择.

Liver failure is characterized by hepatic encephalopathy, jaundice, hypo-coagulation and high mortality.Artificial liver support aims to temporarily replace hepatic function until liver function recover or bridge to liver transplantation.Individualized artificial liver support should be balanced and cover the following aspects： removing albumin bound toxins and/or water soluble toxins, eliminating inflammatory mediators and correcting blood coagulation disorders, in order to support metabolism and modulate immune function and to promote the regeneration of hepatocyte and reverse multiple organ failure that may lead to death of patients.Traditional non-biological artificial liver support can＆#39;t meet individualized treatment.Recently developed hybrid blood purification model, such as albumin dialysis, fractionated plasma separation and adsorption （Prometheus system） and plasma diafiltration （PDF） have provided more and better choices for individualized artificial liver support.Based on the characteristics of pathophysiology and organ dysfunction of liver failure, the author has designed an alignment diagram of individualized artificial liver support for clinical selection.