Inoue K, Watanabe T, Hirasawa H, Yoshiba M
Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Minerva Gastroenterol Dietol. 2010 Sep;56(3):345-53.
A meta-analysis of the efficacy of artificial liver support (ALS) systems for fulminant hepatic failure (FHF) by the Cochrane Hepato-Biliary Group suggested that all ALS systems previously developed are ineffective for FHF. This supports the view that the only treatment of choice for FHF is immediate liver transplantation. Plasma exchange, in combination with high-volume hemodiafiltration or high-flow continuous hemodiafiltration using large pore membranes, which was excluded from the Cochrane meta-analysis because of the lack of randomized control trials, has become a standard ALS system in Japan. This system is safe, and it efficiently removes more low and middle molecular weight toxic substances than other methods by using a large volume of buffers (more than 200 L per session), resulting in recovery from coma in patients with severe FHF comparable to an ahepatic state. These artificial liver support systems are effective tools for sustaining patients with FHF in a favorable condition until liver function recovers or liver transplantation becomes available.
Cochrane肝胆组对人工肝支持（ALS）系统治疗暴发性肝衰竭（FHF）疗效的一项荟萃分析表明，此前开发的所有ALS系统对FHF均无效。这支持了以下观点，即FHF唯一的治疗选择是立即进行肝移植。血浆置换联合使用大孔径膜的高容量血液透析滤过或高流量连续性血液透析滤过，由于缺乏随机对照试验而被排除在Cochrane荟萃分析之外，但已成为日本的标准ALS系统。该系统安全，通过使用大量缓冲液（每次治疗超过200升），比其他方法更有效地清除更多低分子量和中分子量有毒物质，使重度FHF患者从昏迷中苏醒，效果与无肝状态相当。这些人工肝支持系统是将FHF患者维持在良好状态直至肝功能恢复或可进行肝移植的有效工具。
