Matsubara S, Okabe K, Ouchi K, Owada Y
Tohoku J Exp Med. 1986 Sep;150(1):83-90. doi: 10.1620/tjem.150.83.
To evaluate the efficacy of blood purification by plasma exchange in patients with liver failure, blood levels of total bilirubin and total bile acids, known to be a part of protein-bound toxins, were measured before and after plasma exchange. With one plasma volume exchange the percent reduction was 39 for bilirubin and only 25 for bile acids. The declining of the reduction efficiency appeared to be well correlated with the prolongation of the treatment time for bilirubin and the augmentation of the initial concentration for bile acids. These data suggested that the equilibration between intra-and extra-vascular pool takes place slowly for bilirubin and comparatively rapidly for bile acids, though they are both mostly bound to albumin in the blood. In addition, the presence of protein-bound toxins like bile acids, predominantely accumulated in the tissue, may make it more difficult to support patients with liver failure by only blood purification therapy with plasma exchange.
为评估血浆置换血液净化疗法对肝衰竭患者的疗效，在血浆置换前后测量了已知为蛋白结合毒素一部分的总胆红素和总胆汁酸的血药浓度。单次置换一个血浆量后，胆红素降低了39%，而胆汁酸仅降低了25%。降低效率的下降似乎与胆红素治疗时间的延长以及胆汁酸初始浓度的增加密切相关。这些数据表明，尽管胆红素和胆汁酸在血液中大多与白蛋白结合，但血管内和血管外池之间的平衡对于胆红素来说发生得较慢，而对于胆汁酸来说相对较快。此外，像胆汁酸这样主要在组织中蓄积的蛋白结合毒素的存在，可能使得仅通过血浆置换血液净化疗法来支持肝衰竭患者变得更加困难。
