Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Artif Organs. 2009 Aug;33(8):648-53. doi: 10.1111/j.1525-1594.2009.00758.x. Epub 2009 Jun 28.
Albumin dialysis is widely accepted as a liver-support technique for patients with liver failure. The Molecular Adsorbent Recirculating System, the widely accepted albumin dialysis technique, has limited use in developing countries because of its technical difficulties and high cost. Therefore, we assessed the efficacy of the more practical modality, the single-pass albumin dialysis (SPAD), in terms of bilirubin reduction, as a marker of albumin-bound toxins removal, as well as the patient outcomes. Twelve acute or acute-on-chronic patients with liver failure who had hyperbilirubinemia (total bilirubin > 20 mg/dL) were treated with SPAD by using 2% human serum albumin dialysate for 6 h. SPAD treatment significantly improved the levels of total bilirubin, conjugated bilirubin, urea, and creatinine (P < 0.001 for all parameters). The reduction ratios of these four parameters were 22.9 +/- 3.8%, 20.9 +/- 5%, 19.0 +/- 4.1%, and 27.7 +/- 3.2%, respectively. No significant difference was observed between serum ammonia before and after treatment. No significant changes in mean arterial pressures were noted during the maneuver, representing cardiovascular tolerability. No treatment-related complications were found. The 15-day in-hospital survival was 16.7%. However, a subgroup of the patients who had moderate severity showed 100% 15-day-survival rate (2 of 2 patients). In conclusion, SPAD is salutarily effective in reducing bilirubin in patients with liver failure. The procedure is safe and simply set up.
白蛋白透析被广泛认为是肝功能衰竭患者的一种肝脏支持技术。分子吸附再循环系统（MARS）是一种广泛接受的白蛋白透析技术，但由于其技术难度和高成本，在发展中国家的应用受到限制。因此，我们评估了更为实用的单通道白蛋白透析（SPAD）在胆红素降低方面的疗效，胆红素降低是白蛋白结合毒素清除的标志物，同时评估了患者的预后。12 例急性或慢加急性肝功能衰竭伴高胆红素血症（总胆红素>20mg/dL）的患者接受了 2%人血清白蛋白透析液治疗 6 小时的 SPAD 治疗。SPAD 治疗显著改善了总胆红素、结合胆红素、尿素和肌酐的水平（所有参数的 P 值均<0.001）。这四个参数的降低率分别为 22.9±3.8%、20.9±5%、19.0±4.1%和 27.7±3.2%。治疗前后血清氨水平无显著差异。在操作过程中，平均动脉压无明显变化，代表心血管耐受性。未发现与治疗相关的并发症。15 天院内生存率为 16.7%。然而，中度严重程度的患者亚组显示出 100%的 15 天生存率（2 例患者中的 2 例）。总之，SPAD 可有效降低肝功能衰竭患者的胆红素水平。该操作安全且易于设置。
