Azzena G, Morsiani E
Ann Ital Chir. 1999 Sep-Oct;70(5):647-50.
Acute liver failure is very life-threatening since the conventional medical treatments have little effects on the clinical outcome. Artificial liver support systems based on blood detoxification alone have proven ineffective because they cannot correct the severe biochemical disorders. An effective liver support system should be capable of carrying out essential functions such as phase I reaction in which lipid-soluble toxic substance are rendered water-soluble by the enzyme system of the cytochrome P450 and NADPH-cytochrome reductase, and are therefore conjugated by the phase II reaction, before excretion. Liver support systems should be capable of sustaining patients with fulminant liver failure until an organ is available for liver transplantation (bridging treatment), or improving the survival in patients for whom liver transplantation is not a therapeutic option. Recent advances in cell biology and tissue culture techniques have led the way for potential clinical use of isolated hepatocytes so that they are now an important element of bioartificial liver support devices. Some of these systems are currently under clinical investigation in the USA and Europe, and the results of the prospective controlled trials will be soon available.
急性肝衰竭非常危及生命，因为传统医学治疗对临床结果几乎没有效果。仅基于血液解毒的人工肝支持系统已被证明无效，因为它们无法纠正严重的生化紊乱。有效的肝支持系统应能够执行基本功能，如I相反应，在该反应中，脂溶性有毒物质通过细胞色素P450和NADPH - 细胞色素还原酶的酶系统变为水溶性，因此在排泄前通过II相反应进行结合。肝支持系统应能够维持暴发性肝衰竭患者的生命，直到有肝脏可供肝移植（桥接治疗），或者提高肝移植不是治疗选择的患者的生存率。细胞生物学和组织培养技术的最新进展为分离肝细胞的潜在临床应用开辟了道路，因此它们现在是生物人工肝支持装置的重要组成部分。其中一些系统目前正在美国和欧洲进行临床研究，前瞻性对照试验的结果将很快公布。
