基于猪肝细胞的混合型生物人工肝对重型肝炎支持作用的临床研究

Supporting effects of porcine cell-based hybrid bioartificial liver on patients with gravis hepatitis

目的 观察 5例经混合型生物人工肝治疗的急性或亚急性重症肝炎病人的治疗效果 ,探讨混合型生物人工肝治疗的临床意义。方法 5例重症肝炎肝功能衰竭病人 (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 ,时间为 10～ 12h ,于治疗前、治疗中、治疗后分 4个不同时段取血分别测肝功能、血氨、凝血酶原活动度及血清内毒素水平 ,并观察临床症状及体征变化。结果 3例治疗前伴肝性脑病病人昏迷程度减轻。与治疗前比较 ,病人血清总胆红素及内毒素水平明显降低 (P <0 0 1) ,凝血酶原活动度及胆碱脂酶显著升高 (P <0 0 1和P <0 0 5 )。 2例病人痊愈 ,1例 1周后成功实施肝移植 ,其余 2例分别存活 8d和 2 1d ,存活率为 6 0 %。结论 混合型生物人工肝可能是治疗急性重型肝炎肝衰竭的有效方法 ,并作为判断病人能否自然恢复或必须进行肝移植的主要指标。

ObjectiveTo investigate the therapeutic effects of hybrid bioartificial liver (HBL) on patients with acute and sub-acute liver failure. MethodsFive patients with liver failure including 3 acute and 2 sub-acute were treated with HBL consisting of plasma exchange and porcine hepatocytes-based bioartificial liver. The clinical signs and symptoms, total serum bilirubin (TBIL), ammonia, endotoxin and prothrombin activity (PTA), cholinesterase (CHE) were recorded or detected before, during and after the treatment. ResultsThree patients with hepatic coma were improved in level of encephalopathy. PTA and CHE were significantly increased while the serum TBIL and endotoxin decreased in all the patients (P<0.01). Two patients were bridged for spontaneous recovery and 1 for OLT successfully. The left 2 died on the 8th and 21st day after the treatment. During treatment, there were no severe complications such as hemorrhage and allergic reaction etc. ConclusionsHBL may be an effective method to treat patients with acute and sub-acute liver failure. Meanwhile, it can be used as an effective sign to determine whether the liver can recover spontaneously.