应用MARS人工肝治疗急慢性重型肝炎临床研究

Clinical Study on the Molecular Adsorbent Recirculating System (MARS) in Severe Hepatitis

探讨分子吸附再循环系统(MARS)人工肝支持系统治疗重型肝炎的疗效和安全性。方法7例重型肝炎患者在内科综合治疗同时,加用MARS人工肝治疗。MARS人工肝治疗每次持续6～8h。结果7例重型肝炎患者在MARS治疗后,血总胆红素和总胆酸分别由(410.90±256.99)μmol/L和(107.37±69.78)μmol/L降至(310.60±88.97)μmol/L和(60.96±36.27)μmol/L(P<0.001);肌苷和尿素分别由(234.43±90.83)mmol/L和(12.64±5.29)mmol/L降至(93.29±45.27)mmol/L和(6.59±3.73mmol/L(P<0.05);凝血酶原时间(PT)和活化部分凝血酶时间(APTT)分别由(26.81±)13.01s)和(57.54±18.44)s缩短至(17.98±4.52)s和(40.57±11.14)s(P<0.05MARS治疗前后患者血K+、Na+、白细胞和);血小板无显著改变(P>0.05);在MARS治疗期间患者血压、脉搏稳定。4例合并肝肾综合征(HRS)患者中,2例经MARS治疗病情好转,肾功能改善。结论MARS人工肝支持系统是治疗重型肝炎及合并HRS有效和安全的方法。

Objective To evaluate the effect and safety of the molecular adsorbent recirculating system (MARS) in the treatment of patients with severe hepatitis. Methods Seven patients with liver failure (5 patients with subacute severe hepatitis,2 patients with chronic severe hepatitis) were treated with MARS lasting for 6 to 8 hours combined with standard medical therapy. Results The following changes were observed pre- and post-treatment of MARS in 7 patients total bilirubin from(410.90±256.99) μmol/L decreased to (310.60±88.97) μmol/L,bile acid from (107.37±69.78) μmol/L decreased to (60.96±36.27)μmol/L (all P<0.001);creatine from (234.43±90.83) mmol/L decreased to (93.29±45.27) mmol/L,urea from (12.64±5.29) mmol/L decreased to (6.59±3.73) mmol/L,prothrombin time(PT) from (26.81±13.01) seconds decreased to (17.98±4.52) seconds,activated partial thrombin time(APTT) from (57.54±18.44) seconds decreased to (40.57±11.14) seconds (all P<0.05);no significant difference was found in plasma Na+,K+,white blood cells and platelet of the patients;but all patients had stable blood pressure (BP) and pulse (P) during the treatment of MARS. Two of 4 patients with hepatorenal syndrome (HRS) were improved and cured after treatment with MARS. Conclusion The MARS is an effective and safe approach in severe hepatitis associated with HRS.