Karvellas Constantine J, Gibney Noel, Kutsogiannis Demetrios, Wendon Julia, Bain Vincent G
University of Alberta Liver Unit, Zeidler-Ledcor Building, 130 University Campus, Edmonton, Alberta, T6G 2X8 Canada.
Crit Care. 2007;11(3):215. doi: 10.1186/cc5922.
Acute liver failure (ALF) and acute on chronic liver failure (AoCLF) carry a high mortality. The rationale for extracorporeal systems is to provide an environment facilitating recovery or a window of opportunity for liver transplantation. Recent technologies have used albumin as a scavenging molecule. Two different albumin dialysis systems have been developed using this principle: MARS (Molecular Adsorbent Recirculation System) and SPAD (Single-Pass Albumin Dialysis). A third system, Prometheus (Fractionated Plasma Separation and Adsorption), differs from the others in that the patient's albumin is separated across a membrane and then is run over adsorptive columns. Although several trials have been published (particularly with MARS), currently there is a lack of controlled studies with homogenous patient populations. Many studies have combined patients with ALF and AoCLF. Others have included patients with different etiologies. Although MARS and Prometheus have shown biochemical improvements in AoCLF and ALF, additional studies are required to show conclusive benefit in short- and long-term survival. The appropriate comparator is standard medical therapy rather than head-to-head comparisons of different forms of albumin dialysis.
急性肝衰竭（ALF）和慢加急性肝衰竭（AoCLF）的死亡率很高。体外系统的基本原理是提供一个有利于恢复的环境或为肝移植创造一个机会窗口。最近的技术使用白蛋白作为清除分子。基于这一原理开发了两种不同的白蛋白透析系统：分子吸附再循环系统（MARS）和单次通过白蛋白透析（SPAD）。第三种系统，普罗米修斯（分级血浆分离吸附），与其他系统的不同之处在于，患者的白蛋白通过膜进行分离，然后流经吸附柱。尽管已经发表了几项试验（特别是关于MARS的试验），但目前缺乏针对同质患者群体的对照研究。许多研究将ALF和AoCLF患者合并在一起。其他研究纳入了不同病因的患者。尽管MARS和普罗米修斯在AoCLF和ALF中显示出生化指标的改善，但仍需要更多研究来证明其对短期和长期生存的确切益处。合适的对照是标准医学治疗，而不是不同形式白蛋白透析的直接比较。
