分子吸附循环系统治疗肝衰竭52例  

Application of molecular adsorbents recirculating system in the treatment for liver failure of hepatitis B

作　　者：陈士彬[1] 张伦理[1] 史宇飞[1] 杨小兰[1] 王芝花[1] 

机构地区：[1]江西医学院第一附属医院感染科,330006

出　　处：《中华肝脏病杂志》2004年第3期131-133,共3页Chinese Journal of Hepatology

摘　　要：目的 评价分子吸附循环系统(MARS)治疗重型乙型肝炎肝衰竭的疗效,并探讨其机理。 方法 应用MARS对重型乙型肝炎肝衰竭的患者在常规治疗的基础上进行每次6～8h的MARS治疗,治疗前后检测各种有毒物质的改变,并与血浆置换组、常规治疗组进行比较。 结果 52例重型乙型肝炎肝衰竭患者。经MARS治疗后,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、白细胞介素-6、肿瘤坏死因子水平明显降低,治疗前后分别为(521.5±122.5)μmol/L和(360.1±81.2)μmol/L、(227.1±66.7)μg/ml和(105.0±42.0)μg/ml、(12.3±5.4)mmol/L和(6.4±2.4)mmol/L、(37.0±24.0)×10-3g/L和(23.0±16.0)×103g/L、(1.4±0.9)Eu/ml和(0.2±0.2)Eu/ml、(10.1±1.3)pg/ml和(5.7±1.0)pg/ml、(28.5±11.6)μg/ml和(1 7.9±7.8)μg/ml,t值为2.303～4.702,P<0.05或0.01。MARS与血浆置换在治疗后清除胆红素差异无显著性,而治疗后72 h血胆红素反跳,血浆置换组明显高于MARS组。总体存活率:MARS治疗组50％(26/52),血浆置换组45％(9/20),而常规治疗组存活率40.5％(17/42),MARS治疗组与常规治疗组相比较差异有显著性,u=3.024,P<0.01。 结论 MARS人工肝治疗肝衰竭,可明显提高其存活率,无明显不良反映。Objective To evaluate the effect of treatments with the molecular adsorbents recirculating system (MARS) on liver failure patients of severe hepatitis B, in order to seek a 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. Parameters in blood chemical data were collected before and after every treatment and analyzed in comparison with those parameters 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 serum bilirubin, ammonia, urea nitrogen, fragrant amino acid, endotoxin, IL-6, and TNF-α levels (P < 0.05); at the 72 hours bilirubin rebounding analysis. MARS treatments resulted in a significant decrease of bilirubin rebounding level in comparison with what PE did (P < 0.01), though the bilirubin removal efficiency between two groups were not statistically significant. The overall survival rate of MARS therapy was 50% (26/52), which was better than that of standard medical therapy (40.5%, 17/42, P < 0.05). Conclusion The results indicated that MARS was a safe and promising technology in the field of liver support therapy. It might be associated with considerable improved survival rate for liver failure patients.

关 键 词：分子吸附循环系统 治疗 肝衰竭 重型乙型肝炎 血浆置换 

分 类 号：R575.3[医药卫生—消化系统]