分子吸附再循环系统治疗肝衰竭多脏器功能不全

The treatment of molecular adsorbents recirculating system artificial liver in severe liver failure patients with multiple organ dysfunction syndrome

目的 评价分子吸附再循环系统(MARS)对肝衰竭合并多脏器功能不全(MODS)患者的治疗作用和机制。方法 24例肝衰竭合并MODS患者进行了60次6～24 h的MARS治疗。结果 MARS治疗可有效清除白蛋白结合毒素和水溶性毒素,降低一氧化氮(NO)及肿瘤坏死因子-α,白细胞介素-6、-8,和γ干扰素等细胞因子水平,改善肝性脑病、肾功能、呼吸功能以及血流动力学紊乱,序贯性脏器衰竭评估(SOFA)的计分由9.72±1.89降至6.98±2.34,24例危重肝衰竭患者中9例痊愈出院或接受肝移植,总存活率为37.5％。结论 MARS人工肝支持系统对肝衰竭合并MODS有肯定的治疗作用,其疗效除与全面清除肝衰竭蓄积的毒素外,尚与降低NO及细胞因子水平有关。

Objective To evaluate the effectiveness and mechanisms of molecular adsorbents recirculating system (MARS) treatment in severe liver failure patients with multiple organ dysfunction syndrome (MODS). Methods 60 single MARS treatments were performed for 6-24 hours on 24 severe liver failure patients with MODS. Results MARS therapy was associated with marked reduction of albumin bound toxins and water soluble toxins, together with a significant removal of NO and certain cytokines, such as TNF-α, 1L-6, IL-8, and INF-γ. These were associated with a improvement of the patients' clinical conditions including hepatic encephalopathy, deranged hemodynamic situation, as well as renal and respiratory function, thus resulted into marked decrease of sequential organ failure assessment (SOFA) score (from 9.72 ±1.89 to 6.98±2.34), and improving outcome: 9 patients were able to be discharged from the hospital or bridged to successful liver transplantation. The overall survival rate of 24 patients was 37.5%. Conclusions There is positive therapeutic impact and safety to use MARS on liver failure patients with MODS. The effectiveness of MARS is correlated with reducing the levels of NO and cytokines, except for completely removing of accumulated toxins in liver failure patients.