Wang Ying-Jie, Wang Ze-Wen, Luo Bing-Wei, Liu Hong-Ling, Wen Hong-Wei
Institute of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
World J Gastroenterol. 2004 Mar 15;10(6):837-40. doi: 10.3748/wjg.v10.i6.837.
To observe the adsorbent effect of resin on endotoxin, cytokine, bilirubin in plasma of patients with hepatic failure and to determine the resin perfusion as an artificial liver support system in the treatment of hepatic failure.
One thousand milliliters of discarded plasma was collected from each of 6 severe hepatitis patients treated with plasma exchange. The plasma was passed through a resin perfusion equipment for 1-2 h via extracorporeal circulation, and then absorbent indicators of transaminase, bilirubin, blood ammonia, endotoxin and cytokines were examined. In the meantime, study of in vivo resin plasma perfusion was performed on 7 severe hepatitis patients to compare the changes of endotoxin and cytokines in blood before and after perfusion.
The levels of total bilirubin, endotoxin, interleukin 1beta and TNF-alpha in plasma were significantly decreased after in vitro resin plasma perfusion. The levels of interleukin 1beta, TNF-alpha and endotoxin in blood were also evidently declined after in vivo resin plasma perfusion. Nevertheless, no obvious changes in IL-6, creatinine (Cr) and urea nitrogen (UN), blood ammonia and electrolytes were found both in vitro and in vivo.
Bilirubin, endotoxin and cytokines in plasma of patients with hepatic failure can be effectively adsorbed by resin in vitro. Most cytokines and endotoxin in plasma can also be effectively removed by resin in vivo. It demonstrates that resin perfusion may have good treatment efficacy on hepatic failure and can be expected to slow down the progression of hepatic failure.
观察树脂对肝衰竭患者血浆中内毒素、细胞因子、胆红素的吸附作用，确定树脂灌注作为人工肝支持系统治疗肝衰竭的效果。
从6例接受血浆置换治疗的重型肝炎患者中，每人采集1000毫升废弃血浆。血浆通过体外循环经树脂灌注装置1 - 2小时，然后检测转氨酶、胆红素、血氨、内毒素及细胞因子的吸附指标。同时，对7例重型肝炎患者进行体内树脂血浆灌注研究，比较灌注前后血液中内毒素及细胞因子的变化。
体外树脂血浆灌注后，血浆中总胆红素、内毒素、白细胞介素1β及肿瘤坏死因子-α水平显著降低。体内树脂血浆灌注后，血液中白细胞介素1β、肿瘤坏死因子-α及内毒素水平也明显下降。然而，体外及体内实验中白细胞介素-6、肌酐（Cr）、尿素氮（UN）、血氨及电解质均未发现明显变化。
树脂可有效吸附体外肝衰竭患者血浆中的胆红素、内毒素及细胞因子。树脂也可有效去除体内血浆中的多数细胞因子及内毒素。表明树脂灌注对肝衰竭可能具有良好的治疗效果，有望减缓肝衰竭的进展。
