论文部分内容阅读
目的观察三种混合型生物人工肝支持系统(HBLSS)治疗中、晚期慢性重型肝炎的临床效果。方法构建猪肝细胞中空纤维管型生物人工肝系统(BAL),构建三种组合方式的HBLSS：BAL与分子吸附再循环系统(MARS)组合；BAL与缓慢血浆置换(SPE)和持续血液透析滤过(CHDF)组合；BAL与缓慢血浆置换(SPE)和血液灌流(HP)组合。120例中、晚期慢性重型肝炎患者被随机均分为6组,治疗组分别接受BAL＋MARS(H1)、BAL＋SPE＋CHDF(H2)和BAL＋SPE＋HP(H3)治疗；对照组分别接受 MARS(C1)、SPE＋CHDF(C2)和SPE＋HP(C3)治疗。观察各组患者在治疗前、治疗结束时、治疗结束后72h的临床症状、肝性脑病、血清总胆红素、凝血酶原活动度、血清内毒素、血氨、肌酐和甲胎蛋白等的变化。观察各组的治愈好转率、不良反应的发生情况。结果治疗组与对照组均能改善患者临床症状、降低总胆红素、血海内毒素、血氨水平,提高凝血酶原活动度和甲胎蛋白水平,但以H1、H2、H3组作用明显。与H3组比较,H1、H2组能显著降低肌酐、血氨。H1、H2、H3、C1、C2、C3的治愈好转率分别为 65％(13／20)、60％(12／20)、45％(9／20)、45％(9／20)、40％(8／20)、20％(4／20)。H1、H2、H3治疗中均未发生严重不良反应。结论 H1、H2、H3组治疗中、晚期慢性重型肝炎的效果优于C1、C2、C3组,其中H2 组和H2组能明显改善肝肾功能,阻断多器官功能衰竭,疗效优于H3组。
Objective To observe the clinical effects of three hybrid bioartificial liver support systems (HBLSS) in the treatment of middle and advanced chronic severe hepatitis. Methods The hollow fiber tube bioartificial liver system (BAL) of porcine hepatocytes was constructed. Three combinations of HBLSS and BAL were combined with MARS. BAL and slow plasma exchange (SPE) and continuous hemodiafiltration (CHDF) combination; BAL is combined with slow plasma exchange (SPE) and hemoperfusion (HP). 120 patients with advanced chronic severe hepatitis were randomly divided into 6 groups, the treatment group received BAL + MARS (H1), BAL + SPE + CHDF (H2) and BAL + SPE + HP (H3) treatment; control group received MARS (C1) And SPE + HP (C3) treatment. The clinical symptoms, hepatic encephalopathy, serum total bilirubin, prothrombin activity, serum endotoxin, blood ammonia, creatinine, and alpha-fetoprotein were observed before treatment, at the end of treatment and 72h after the treatment Variety. Observe the healing rate of each group, the incidence of adverse reactions. Results Both the treatment group and the control group could improve clinical symptoms, reduce total bilirubin, blood sea toxin, blood ammonia level, increase prothrombin activity and alpha-fetoprotein level, but the effect was obvious in H1, H2 and H3 groups. Compared with H3 group, H1, H2 group can significantly reduce creatinine, blood ammonia. The improvement rates of H1, H2, H3, C1, C2 and C3 were 65% (13/20), 60% (12/20), 45% (9/20), 45% % (8/20), 20% (4/20). H1, H2, H3 treatment did not occur in serious adverse reactions. Conclusion The efficacy of H1, H2, H3 group in treating middle and late chronic severe hepatitis is better than that in C1, C2 and C3 groups, and H2 and H2 groups can obviously improve liver and kidney function and block multiple organ failure, and the curative effect is better than that of H3 group .