新型生物人工肝在临床肝移植前的应用效果  

Primary clinical study of a novel bioartificial liver combined with liver transplantation in patients with liver failure

作　　者：施晓雷[1] 韩冰[1] 任昊桢[1] 吴亚夫[1] 江春平[1] 张炜炜[1] 丁义涛[1] 

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,210008

出　　处：《中华器官移植杂志》2014年第4期193-197,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金（81170418）;江苏省肝脏外科临床医学中心（ZX201105）

摘　　要：目的评价新型生物人工肝（BAL）在肝移植前应用的临床效果。方法22例肝功能衰竭患者，分成2组：（1）BAL联合肝移植组（10例）在肝移植前24h先接受BAL治疗，治疗时间为4h；（2）单纯肝移植组（12例）仅接受肝移植。于BAL治疗前、后以及肝移植后抽取患者外周血监测血常规、肝功能、凝血功能等指标，观察患者临床症状及体征的变化，以判定BAL的治疗效果。检测患者血浆及反应器中IgG、IgM及补体溶血活性（CH50）的水平，外周血单个核细胞中猪内源性逆转录病毒DNA、猪特异性细胞色素B基因序列及逆转录酶的活性等，以评估BAL治疗的免疫学和病毒学安全性。记录两组肝移植手术成功率、手术时间、冷缺血时间、手术出血量及肝功能恢复情况。结果移植前BAL联合肝移植组患者接受BAL治疗后感觉良好，乏力、纳差、腹胀等症状有所缓解，肝性脑病减轻，肝功能、血清氨、凝血功能等实验室指标均有不同程度的改善，未发生不良反应，无猪内源性逆转录病毒感染，以及血浆IgG、IgM和CH50无明显变化。两组患者均成功接受改良背驮式肝移植，术中无死亡。两组的手术时间和冷缺血时间的差异均无统计学意义（P〉O．05），术中出血量的差异有统计学意义（P〈0．01）。BAL联合肝移植组患者在肝移植后各个时间点转氨酶、胆红素、血清氨、凝血酶原时间和白细胞等指标较单纯肝移植组均有所改善（P〈0．01或P％0．05）。结论新型BAL能更好地改善肝功能衰竭患者术前状态，为肝移植赢得手术时机。Objective To investigate the safety and therapeutic effects of the novel bioartificial liver （BAL） combined with liver transplantation in patients with liver failure. Method Twenty-two patients with liver failure were admitted. Ten of them were treated with the novel BAL 24 h before liver transplantation, while the rest 12 served as controls and received liver transplantation only. The clinical signs and symptoms, liver function, ammonia, coagulation function and complete blood count were evaluated before, during and after the treatment. Levels of xenoantibodies （IgG and IgM） were detected by ELISA kit. Titers of complement were quantified by CH50 kit. DNA in the collected PBMCs was extracted for PCR with PERV specific primers and the porcine specific primer Sus scrofa cytochrome B. The RT activity was detected as well. The operation related information was recorded, such as operation success rate, operative time, cold ischemia time, bleeding volume in operation and liver function. Result All treatment procedures were completed successfully without any adverse reaction. In the BAL group, the clinical symptoms such as acratia, anorexia and abdominal distension were improved, as well as the stage of hepatic encephalopathy and the results of experimental tests such as liver function, ammonia, and coagulation function. No PERV infection and no obvious changes of the IgG, IgM and CHS0 levels were detected in patients plasma. All patients were successfully bridged to modified pig-back liver transplantation and recovered. There were no differences in operative time and cold ischemia time （P〉0. 05）. However, bleeding volume was different in these two groups （P〈0. 05）. The liver function was improved significantly in BAL group than the control group after liver transplantation （P〈0. 01 ）. Conclusion The novel BAL could improve the internal environment of patients with liver failure, and enhance the safety and efficiency of liver transplantation. The novel BAL combined with liver transplantation c

关 键 词：肝功能衰竭 生物人工肝 肝移植 

分 类 号：R657.3[医药卫生—外科学]