Department of Hepatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Curr Opin Crit Care. 2019 Apr;25(2):187-191. doi: 10.1097/MCC.0000000000000584.
Liver failure is a life-threatening condition, and an artificial liver is highly desirable to replace the failing liver-functions in the waiting time for liver regeneration to happen or until liver transplantation can be undertaken. This review focuses on the efficacy of using artificial extracorporeal liver support devices.
Artificial liver support devices such as the molecular adsorbent recirculating system (MARS), fractionated plasma separation and adsorption, and therapeutic plasma exchange (TPE) are well tolerated. MARS and TPE improve systemic haemodynamics and the grade of hepatic encephalopathy. However, randomized, controlled trials of MARS and fractionated plasma separation and adsorption have failed to show improvement in survival in patients with acute liver failure (ALF) and patients with acute-on-chronic liver failure (ACLF). Only TPE improves survival in patients with ALF by ameliorate the release of ammonia, damage-associated molecular patterns and sB7 (CD80/86) from the necrotic liver. No randomized, controlled trials on survival in patients with ACLF using TPE have been done.
Liver support systems such as MARS and TPE may temporarily improve systemic haemodynamics and the degree of encephalopathy. However, TPE is the only procedure that improves survival in patients with ALF. The role of TPE in ACLF remains unknown.
肝功能衰竭是一种危及生命的疾病，非常需要人工肝脏来替代衰竭的肝脏功能，等待肝脏再生或直到可以进行肝移植。这篇综述重点介绍了使用人工体外肝脏支持设备的疗效。
人工肝脏支持设备，如分子吸附再循环系统（MARS）、分馏血浆分离和吸附以及治疗性血浆置换（TPE），耐受性良好。MARS 和 TPE 改善全身血液动力学和肝性脑病的严重程度。然而，MARS 和分馏血浆分离和吸附的随机对照试验未能显示急性肝衰竭（ALF）和急性慢性肝衰竭（ACLF）患者的生存率有所改善。只有 TPE 通过改善来自坏死肝脏的氨、损伤相关分子模式和 sB7（CD80/86）的释放，改善了 ALF 患者的生存率。尚未进行 TPE 治疗 ACLF 患者生存率的随机对照试验。
MARS 和 TPE 等肝脏支持系统可能会暂时改善全身血液动力学和脑病的严重程度。然而，TPE 是唯一能提高 ALF 患者生存率的方法。TPE 在 ACLF 中的作用尚不清楚。
