中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (25): 4697-4700.doi: 10.3969/j.issn.1673-8225.2010.25.034

• 生物材料临床实践 clinical practice of biomaterials • 上一篇    下一篇

两种人工肝支持系统治疗重型肝炎143例

孙丽华，徐  琴，肖  琳，鲁晓擘，刘  浩，徐  玲，阎桂霞，张跃新   

  1. 新疆医科大学第一附属医院肝病中心，新疆维吾尔自治区乌鲁木齐市  830054
  • 出版日期:2010-06-18 发布日期:2010-06-18
  • 通讯作者: 张跃新，博士，主任医师，博士生导师，新疆医科大学第一附属医院肝病中心，新疆维吾尔自治区乌鲁木齐市 830054 zhangyx3103@163.com
  • 作者简介:孙丽华★，女，1976年生，甘肃省临洮县人，汉族，2004年新疆医科大学毕业，硕士，主治医师，主要从事病毒性肝炎和重型肝炎的研究。 slhxinjiang@sina.com

Curative effect of molecular adsorbents recycling system versus plasma exchange on treatment of severe hepatitis in 143 patients

Sun Li-hua, Xu Qin, Xiao Lin, Lu Xiao-bo, Liu Hao, Xu Ling, Yan Gui-xia, Zhang Yue-xin   

  1. Hepatopathy Center of First Affiliated Hospital of Xinjiang Medical University, Urumqi   830054, Xinjiang Uygur Autonomous Region, China
  • Online:2010-06-18 Published:2010-06-18
  • Contact: Zhang Yue-xin, Doctor, Chief physician, Doctoral supervisor, Hepatopathy Center of First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China zhangyx3103@163.com
  • About author:Sun Li-hua★, Master, Attending physician, Hepatopathy Center of First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China slhxinjiang@sina.com

PDF

406

被引次数

5

摘要：

背景：目前国内外普遍采用人工肝支持系统治疗重型肝炎，而各种支持系统疗效不尽相同，也尚未建立统一的疗效评价体系。
目的：评价分子吸附再循环系统和血浆置换两种人工肝支持系统治疗重型肝炎的临床疗效。
方法：143例重型肝炎患者在药物治疗基础上联合分子吸附再循环治疗或血浆置换治疗，分析治疗前后实验室指标、终末期肝病评分值和3个月病死率。
结果与结论：①分子吸附再循环治疗和血浆置换治疗后总胆红素、胆汁酸、凝血时间、国际标准化比率和终末期肝病评分值均明显降低(P < 0.05)，凝血酶原活动度明显升高(P < 0.05)。但单次血浆置换治疗改善总胆红素、丙氨酸氨基转移酶、凝血时间、部分凝血活酶时间、凝血酶原活动度、国际标准化比率、终末期肝病评分值程度优于分子吸附再循环治疗(P < 0.05)，而分子吸附再循环治疗系统在改善肌酐、胆汁酸、白蛋白方面优于血浆置换治疗(P < 0.05)。②分子吸附再循环治疗组和血浆置换组3个月实际病死率分别为63%，56.5%(P > 0.05)，两者之间无优劣区别，但显著低于3个月预期病死率(P < 0.05)，尤其在终末期肝病评分< 30分的患者中疗效显著。而对于终末期肝病评分≥30分者两种治疗并不能改善预后。结果提示分子吸附再循环和血浆置换均是治疗重型肝炎的有效、安全的肝脏支持装置，终末期肝病评分有助于指导人工肝支持系统的应用并评价其疗效。

关键词: 重型肝炎, 分子吸附再循环系统, 血浆置换, 终末期肝病评分模型, 生物膜材料

Abstract:

BACKGROUND: Artificial liver support system has been commonly used to treat severe hepatitis. However, their effects are varied, and treatment effect evaluation is not uniform.
OBJECTIVE: To evaluate the curative effect of molecular adsorbents recycling system (MARS) and plasma exchange (PE) in the treatment of severe hepatitis.
METHODS: A total of 143 patients with severe hepatitis were treated with MARS or PE. Blood chemical data, scores of model for end-stage liver disease (MELD), and fatality rate in 3 months were analyzed.
RESULTS AND CONCLUSION: MARS and PE therapy significantly decreased total bilirubin (TBIL), bile acid (TBA), prothrombin time, international normalized ratio for prothrombin time and the score of MELD (P < 0.05), but increased prothrombin activity   (P < 0.05). PE had obvious dominance in improving TBIL, alanine transarninase, prothrombin time, activated partial thromboplastin time, prothrombin activity, prothrombin time and MELD (P < 0.05), while MARS had better ability in improving the creatinine, TBA and albumin (P < 0.05). The fatality rate of MARS and PE groups were 63% and 56.5% respectively in 3 months (P > 0.05). But they were lower than the predictable fatality rate (P < 0.05), especially in the group of patients with MELD score less than 30, but for patients with MELD score ≥30, the two treatments did not improve the prognosis. As the hepatic support device, MARS and PE were effective and safe methods for severe hepatitis. MELD can be applied in clinic for evaluating severity, curative effect and indication of hepatic support device treatment.

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