分子吸附剂循环系统用于肝衰竭的肝脏支持治疗：来自中国14个中心的252例病例总结

Liver support therapy with molecular adsorbents recirculating system in liver failure: a summary of 252 cases from 14 centers in China.

作者信息

Wang Min-min, Chen Shi-jun, Ye Qi-fa, Yang Yi-jun, Chen Shi-bin, Zhou Xin-min, Guo Li-min, Zhang Yue-xin, Ding Xiao-qiang, Hu Xiao-bin, Luo Hong-tao, Liu Yi-he, Wang Wen-ya

机构信息

Therapeutic Blood Purification Research Center, University of Rostock, Germany.

出版信息

Chin Med J (Engl). 2008 Nov 5;121(21):2197-201.

PMID:19080184

Abstract

BACKGROUND

A liver support therapy, named molecular adsorbents recirculating system (MARS), has been used for more than 700 liver failure patients in China. We made here a summary to evaluate the effects of MARS treatment in different applications with emphasis on hepatitis B virus (HBV) based liver failure.

METHODS

This report analyzed data of 252 patients (mean age (44.9+/- 12.7) years) in three groups: acute severe hepatitis (ASH), subacute severe hepatitis (SSH) and chronic severe hepatitis (CSH). The largest group was CSH (156 patients, 61.9%), and 188 patients (74.6%, 188/252) were infected with HBV.

RESULTS

MARS treatments were associated with significant reduction of albumin bound toxins and water-soluble toxins. Most of the patients showed a positive response with a significant improvement of multiple organ function substantiated by a significant increase in prothrombin time activity (PTA) and median arterial pressure (MAP). There was a decrease in hepatic encephalopathy (HE) grade and Child-Turcotte-Pugh (CTP) scale. Thirty-nine of 188 HBV patients (20.7%) dropped out of the commendatory consecutive therapy ending with lower survival of 43.6% while the rest of the 149 patients had a survival rate of 62.4%. Survival within the ASH and SSH groups were 81.2% and 75.0%, respectively. In the CSH group, end stage patients were predominant (65/151, 43%), whereas the early and middle stage patients had a better prognosis: early stage survival, including orthotopic liver transplantation (OLT) survival of 91.7%, middle stage survival of 75%, end stage survival of 33.8%.

CONCLUSIONS

MARS continues to be the most favorable extracorporeal treatment for liver support therapy in China for a wide range of conditions, including the majority of hepatitis B related liver failure conditions. The appropriate application of MARS for the right indications and stage of hepatic failure, as well as the fulfillment of prescribed treatments, will lead to the optimal therapeutic result.

摘要

背景

一种名为分子吸附再循环系统（MARS）的肝脏支持疗法已在中国应用于700多名肝衰竭患者。我们在此进行总结，以评估MARS治疗在不同应用中的效果，重点关注基于乙型肝炎病毒（HBV）的肝衰竭。

方法

本报告分析了三组252例患者（平均年龄（44.9±12.7）岁）的数据：急性重型肝炎（ASH）、亚急性重型肝炎（SSH）和慢性重型肝炎（CSH）。最大的组是CSH（156例患者，61.9%），188例患者（74.6%，188/252）感染了HBV。

结果

MARS治疗与白蛋白结合毒素和水溶性毒素的显著降低相关。大多数患者显示出阳性反应，凝血酶原时间活动度（PTA）和平均动脉压（MAP）显著增加，证实多器官功能有显著改善。肝性脑病（HE）分级和Child-Turcotte-Pugh（CTP）评分降低。188例HBV患者中有39例（20.7%）退出推荐的连续治疗，最终生存率为43.6%，而其余149例患者的生存率为62.4%。ASH组和SSH组的生存率分别为81.2%和75.0%。在CSH组中，终末期患者占主导（65/151，43%），而早期和中期患者预后较好：早期生存率，包括原位肝移植（OLT）生存率为91.7%，中期生存率为75%，终末期生存率为33.8%。