甲磺酸萘莫司他在行人工肝支持系统治疗的肝衰竭高胆红素血症患者中的应用  

Application of nafamostat mesylate in hyperbilirubinemia patients with hepatic failure treated by artificial liver support system

作　　者：郭玥 段连香 刘文瑞[1] 刘子洋 路建饶[1] 胡静[1] GUO Yue;DUAN Lianxiang;LIU Wenrui;LIU Ziyang;LU Jianrao;HU Jing(Department of Nephrology,Shanghai Seventh People's Hospital,Shanghai 200137,China)

机构地区：[1]上海市第七人民医院肾病科,上海200137

出　　处：《世界临床药物》2024年第4期397-402,共6页World Clinical Drug

基　　金：国家自然科学基金项目(82304921);中医高峰学科(YC-2023-0602)。

摘　　要：目的评估甲磺酸萘莫司他(nafamostat mesylate,NM)在行人工肝支持系统(artificial liver support system,ALSS)治疗的肝衰竭(hepatic failure,HF)高胆红素血症患者中的有效性及安全性。方法选取2020年9月至2023年3月于我院接受ALSS的HF患者54例,其中28例以NM抗凝,26例以低分子肝素(low molecular weight heparin,LMWH)抗凝。所有患者接受2次治疗,每次治疗时间为3 h。观察并检测透析器凝血情况、出血并发症、不良反应、总胆红素(total bilirubin,TBil)下降率,以及30、90 d生存率。结果治疗时,两组血液流速差异无统计学意义(P>0.05)。治疗后,NM组TBil下降率较LMWH组差异无统计学意义[(60.43±6.29)%vs(61.27%±6.45)%,P>0.05]。两组透析器凝血情况、输注红细胞、低血压、30、90 d生存率及恶心呕吐情况差异均无统计学意义(P>0.05)。NM组无胃肠道出血的情况,LMWH组出现4例胃肠道出血,差异有统计学意义(P<0.05)。结论NM较LMWH不增加行ALSS的HF患者的出血风险,是一种安全、有效的抗凝剂。Objective To evaluate the efficacy and safety of nafamostat mesylate(NM)in hyperbilirubinemia patients with hepatic failure(HF)treated with artificial liver support system(ALSS).Methods A total of 54 HF patients who received ALSS in our hospital from September 2020 to March 2023 were selected,of which 28 were treated with NM anticoagulation and 26 were treated with low molecular weight heparin(LMWH).All patients received two treatments,each lasting 3 hours.Hemodialyzer coagulation,bleeding complications,adverse reactions,total bilirubin(TBil)reduction rate,30,90 days survival rate were observed and measured.Results There was no significant difference in blood flow rate between the two groups(P>0.05).After treatment,there was no significant difference in the reduction rate of TBil in the NM group compared with the LMWH group[(60.43±6.29)%vs(61.27%±6.45)%,P>0.05].There were no significant differences in dialyzer coagulation,red blood cell transfusion,hypotension,30,90 days survival rate and nausea and vomiting between the two groups(P>0.05).There was no gastrointestinal bleeding in the NM group,and 4 cases in the LMWH group,the difference was statistically significant(P<0.05).Conclusion Compared with LMWH,NM does not increase the risk of bleeding in HF patients undergoing ALSS,and is a safe and effective anticoagulant.

关 键 词：甲磺酸萘莫司他 人工肝支持系统 肝衰竭 高胆红素血症 低分子肝素 抗凝剂 

分 类 号：R575.3[医药卫生—消化系统]