成功应用分子吸附再循环系统（MARS）透析治疗因误食有毒蘑菇意外中毒的儿童暴发性肝衰竭。

Successful use of Molecular Absorbent Regenerating System (MARS) dialysis for the treatment of fulminant hepatic failure in children accidentally poisoned by toxic mushroom ingestion.

作者信息

Covic Adrian, Goldsmith David J A, Gusbeth-Tatomir Paul, Volovat Carmen, Dimitriu Alexandru G, Cristogel Florin, Bizo Aurel

机构信息

Dialysis Center, University Hospital, Iasi, Romania.

出版信息

Liver Int. 2003;23 Suppl 3:21-7. doi: 10.1034/j.1478-3231.23.s.3.9.x.

DOI:10.1034/j.1478-3231.23.s.3.9.x

PMID:12950957

Abstract

BACKGROUND

Acute liver failure (ALF) as a result of mushroom poisoning is associated with a high mortality (particularly in children), despite optimal medical therapy (OMT), including charcoal haemoperfusion and haemodiafiltration. MARS is a new, cell-free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin-bound toxins.

METHODS

We describe the first series in the literature (also first MARS treatments in Romania) with ALF because of mushroom poisoning in children (M/F=2/4, age=7-16 years). Liver function was evaluated pre-MARS and 15-min post-MARS, 24 h following each treatment and 30 days post-MARS.

FINDINGS

All patients had severe hepatic dysfunction: hepatic encephalopathy (HE; four grade II, one grade III, one grade IV), ALT=4082 (3400-5600) IU/L, bilirubin=6.3 (2-10) mg/dL, prothrombin time (PT)=52.5 (23-141) s. MARS was uneventful and well-tolerated. Two 6-h sessions per patient were performed with a similar immediate impact on liver tests: mean drop in ALT of -33 and -35%, respectively, and in bilirubin of -39 and -36%, respectively. ALT levels 24 h following MARS-1, remained unchanged but continued to drop by a further -28% following MARS-2. By contrast, all patients had a significant rebound in bilirubin (+39%) 24 h following MARS-1; however, following MARS-2 a rebound was seen only in two cases (+220%). PT improved by 37% after MARS-1 and normalized in four patients after MARS-2.

OUTCOME

Four patients survived and completely recovered the hepatic function. Negative prognostic markers: lack of complete correction of PT, continuous rebound and increase in bilirubin, and lack of improvement in HE post-MARS-1. Survival in six well-matched cases, treated by OMT=0/6 (P<0.05).

CONCLUSIONS

MARS is a safe and highly effective depurative therapy in children with ALF. Survival is predicted only by the impact/results of the initial MARS sessions and not by any of the baseline parameters.

摘要

背景

尽管采用了包括活性炭血液灌注和血液透析滤过在内的最佳药物治疗（OMT），蘑菇中毒导致的急性肝衰竭（ALF）仍具有较高的死亡率（尤其是在儿童中）。MARS是一种新的无细胞体外肝脏辅助方法，利用白蛋白透析液清除与白蛋白结合的毒素。

方法

我们描述了文献中的首个系列病例（也是罗马尼亚的首例MARS治疗），为儿童蘑菇中毒所致的ALF（男/女=2/4，年龄7 - 16岁）。在MARS治疗前、治疗后15分钟、每次治疗后24小时以及MARS治疗后30天评估肝功能。

研究结果

所有患者均有严重肝功能障碍：肝性脑病（HE；4例为II级，1例为III级，1例为IV级），谷丙转氨酶（ALT）=4082（3400 - 5600）IU/L，胆红素=6.3（2 - 10）mg/dL，凝血酶原时间（PT）=52.5（23 - 141）秒。MARS治疗过程顺利，耐受性良好。每位患者进行了两个6小时的疗程，对肝功能检查有相似的即时影响：ALT平均分别下降33%和35%，胆红素分别下降39%和36%。MARS - 1治疗后24小时ALT水平保持不变，但在MARS - 2治疗后继续下降了28%。相比之下，所有患者在MARS - 1治疗后24小时胆红素均有显著反弹（+39%）；然而，在MARS - 2治疗后仅2例出现反弹（+220%）。MARS - 1治疗后PT改善了37%，4例患者在MARS - 2治疗后恢复正常。