中国血液净化

›› 2004, Vol. 3 ›› Issue (11): 617-619.

• 人工肝 • 上一篇    下一篇

人工肝支持系统在治疗重型肝炎中的临床应用

赵显国 王 凯 李素珍 王欣芳 张蓓蕾 于爱萍   

  1. 450052 郑州，郑州大学第一附属医院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-11-12 发布日期:2004-11-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-11-12 Published:2004-11-12

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摘要：

目的 探索人工肝支持系统（ ALSS）治疗重型肝炎的临床疗效和机制。方法 对71例重型肝炎患者在综合疗法的基础上给予ALSS治疗，观察治疗前后临床表现，监测治疗前后肝功能、凝血酶原活动度(PTA)、肿瘤坏死因子-α（TNF-α）、内毒素及一氧化氮（NO）水平。并比较重型肝炎不同类型及时期应用ALSS的治疗效果。结果 重型肝炎患者在ALSS治疗后，肝功能明显改善，白蛋白、凝血酶原活动度(PTA)较治疗前明显提高，TNF-α、内毒素及NO水平明显下降。急性、慢性重型肝炎应用ALSS治疗治愈好转率分别为61.5％、25.6％，慢性重型肝炎早、中、晚期治疗治愈好转率分别为72％、42％、0％。结论 ALSS治疗重型肝炎疗效可靠，急性重型肝炎的治疗效果较好，慢性重型肝炎在早、中期治疗最为适宜，并能降低TNF-α、内毒素及NO等病理成分，从而减轻重型肝炎时免疫反应对肝细胞的损伤，能明显提高其生存率。ALSS后生化监测和临床表现能提示预后。

关键词: 人工肝支持系统, 重型肝炎, TNF-α, 内毒素, 一氧化氮

Abstract:

Objective To study the efficacy as well as the mechanism of artificial liver support system（ALSS）in the treatment of hepatitis gravis. Methods Seventy-one patients suffering from hepatitis gravis were treated with artificial liver support system on the basis of conventional therapy．The liver function，prothrombin activity（PTA）， serum tumor necrosis factor alpha（TNF-α），endotoxin，nitrogen monoxide（NO）and clinical symptoms were observed．And the efficacy of ALSS treatment on the different stages and different types of hepatitis gravis were investigated．Results After treating with artificial liver support system ，the clinical symptoms of the hepatitis gravis patients were ameliorated．The levels of serum albumin and PTA increased obviously (P<0.05～0.01)． The levels of plasma PT, total bilirubin，serum ammonia，TNF-α，endotoxine and NO decreased significantly ( P<0.05～0.001). The response rates of acute and chronic hepatitis gravis were 61.5％ and 25.6％ respectively，and the response rates of chronic hepatitis gravis in early stage，middle stage and late stage were 72%、42%、0% respectively. Conclusions The ALSS is effective in treating hepatitis gravis.It is more suitable to use ALSS in early and middle stage of chronic hepatitis gravis．And ALSS may significantly decrease the levels of pathologic components such as TNF-α、endotoxin and nitrogen monoxide．As a result，ALSS can also alleviate the injury from immunoreaction and increase the survival rate．The clinical symptoms and biochemistry indexes can be used to judge the prognosis of hepatitis gravis after ALSS treatment.

Key words: Hepatitis gravis, TNF-α, Endotoxin, Nitrogen monoxide

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