分子吸附循环治疗重型乙肝肝衰竭52例临床应用研究

Application of Molecular Adsorbents Recirculating System in liver Failure Patients of Severe Hepatitis B

目的 :评价 MARS人工肝支持系统治疗重型乙型肝炎等其它病因所致的肝衰竭 ,探讨肝性脑病的发生机理。从而为临床治疗重型肝炎找到一种安全、有效的新的治疗手段 ,提高重型病毒性肝炎的总体存活率。方法 :应用德国 TERAKLN公司生产的分子吸附循环系统 (MARS)对肝衰竭的患者在常规治疗的基础上进行每次 6～ 8小时的 MARS治疗 ,检测治疗前后各种有毒物质的改变 ,并与血浆置换组、常规治疗组的某些参数进行对照比较结果 :5 2例重型乙型肝炎肝衰竭的患者。经 MARS治疗后 (1)临床症状及体征明显改善 ,血胆红素、血氨、尿素氮、芳香氨基酸、内毒素、IL- 6、TNF- α水平明显降低 (p<0 .0 5 ) (2 ) MARS与血浆置换在治疗后清除胆红素无明显差异(p=0 .1) ,而治疗后 72小时血胆红素反跳 ,血浆置换组明显高于胆红素组 (P<0 .0 1)。 (3)总体存活率 :5 0 % (2 6 / 5 2 )。经 MARS治疗 1次因故而中断 MARS治疗者存活率 :4 5 .5 % (10 / 2 2 )。按设计要求完成 2次以上者存活率达 5 3.3% (16 / 30 )。血浆置换组 4 5 % (9/ 2 0 ) ,而常规治疗组存活率4 0 .5 % (17/ 4 2 )。结论 :MARS人工肝治疗肝衰竭 ,通过选择性地清除体内蛋白结合性及水溶性毒素 ,无明显不良副作用 ,是一项充满希望的新技术。

Objective To evaluate the effect of treatments with the Molecular Adsorbents Recirculating System (MARS) on liver failure patients based on severe hepatitis B,try to make available the safe and effective therapeutic method which contribute to the improved survival rate for severe hepatitis patients.Methods:52 liver failure patients of severe hepatitis B were performed intermittent MARS therapy for 6～8 hours per time in addition to standard medical treatment,changes in blood chemical data were collected before and after every treatment,these laboratory parameters were analyzed in comparison with those detected from controlled groups by means of plasma exchange and standard medical therapy.Results:MARS therapy achieved a remarkable improvement in clinical symptoms and physic signs,accompanied with a significant decrease in bilirubin,ammonia,urea nitrogen,fragrant amino acid,endotoxin,IL 6,and TNF α levels(p<0.05);to the 72 hours bilirubin rebounding analysis,MARS treatments resulted in a significant decrease of bilirubin rebounding level in compared with what PE did(p<0.01),though their bilirubin removal efficiency were not statistically significant.The overall survival rate was 50% (26/52),in part of patients had the survival rate of 45.5%(10/22)due to their giving up sequential MARS therapy after the first time,while the survival rate for the remained patients whose treatments kept to the MARS art strategy was 53.3%(16/30),which was significantly improved than that of standard medical therapy (40.5%,17/42,p<0.05).Conclusions:MARS has proved to be a safe and promising technology in the field of liver support therapys.we confirmed that the art planed MARS treatment might associated with considerable improved survival rate for failure patients.