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目的 通过混合型生物人工肝治疗对急性或亚急性肝炎肝功能衰竭患者血清促炎性细胞因子和内毒素的清除作用 ,探讨其减轻全身炎症反应综合征 (SIRS)的程度并降低多器官功能障碍综合征(MODS)发生的效果。方法 组合型生物人工肝由血浆置换和猪肝细胞型生物人工肝构成。 5例重症肝炎肝功能衰竭患者 (急性重型 3例和亚急性重型 2例 )各行组合型生物人工肝治疗 1次 ,时间约 10～ 12h ,于治疗前、治疗中、治疗后分 3个不同时段取血分别测肝功能、肾功能、血氨、血清TNF -α、IL 6及内毒素水平 ,并监测血液动力学指标和神经系统症状。结果 3例治疗前伴肝性脑病患者昏迷程度减轻。与治疗前比较 ,血清总胆红素 (TBIL)、TNF -α、IL 6及血清内毒素水平明显降低 (P<0 0 1) ,胆碱脂酶 (CHE)、凝血酶原活动度显著升高 (P <0 0 1)。治疗前合并 2种器官衰竭者 4例 ,3种器官衰竭者 1例。治疗后未再继续发展。其中 2例患者痊愈 (2种器官衰竭 ) ,1例 1周后成功实施肝移植 (3种器官衰竭 ) ,其余 2例分别存活 8日和 2 1日 ,治疗后有效为 4 5 ,存活为 3 5。结论 混合型生物人工肝能明显的降低重症肝炎急性期血清促炎性细胞因子和内毒素的水平 ,是遏制从SIRS到MODS病理发展、促进衰竭脏器恢复的有效手段。
Objective To explore the effect of mixed bioartificial liver therapy on the clearance of serum proinflammatory cytokines and endotoxins in patients with acute or subacute hepatic failure, and to explore its effect on reducing the severity of systemic inflammatory response syndrome (SIRS) and reducing the risk of multiple organ dysfunction Syndrome (MODS) the occurrence of the effect. Methods The combined bioartificial liver consisted of plasmapheresis and porcine hepatocyte bioartificial liver. Five patients with severe hepatitis with liver failure (3 cases of acute severe and 2 cases of subacute severe) were treated with combination bioartificial liver for 1 time for 10 ~ 12 hours. Before treatment, during treatment and after treatment, they were divided into 3 different periods Blood was taken to measure liver function, renal function, blood ammonia, serum TNF-α, IL-6 and endotoxin levels, and to monitor hemodynamic parameters and neurological symptoms. Results 3 patients with hepatic encephalopathy before treatment coma decreased. Serum total bilirubin (TBIL), TNF-α, IL-6 and serum endotoxin levels were significantly lower than those before treatment (P <0.01), CHE and prothrombin activities were significantly increased High (P <0 0 1). 4 cases combined with 2 kinds of organ failure before treatment, 1 case with 3 kinds of organ failure. No further development after treatment. Two of the patients recovered (two organ failure), one had a successful liver transplant (three organ failure) one week later, and the remaining two survived on the 8th and 21st days respectively. After treatment, the effective rate was 45 and the survival rate was 3 5. Conclusions Mixed bioartificial liver can significantly reduce serum levels of proinflammatory cytokines and endotoxin in patients with acute severe hepatitis, which is an effective way to restrain the pathological development from SIRS to MODS and to promote the recovery of organ failure.