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混合型生物人工肝治疗慢加急性肝衰竭患者的初步探讨
Preliminary investigation of hybrid bioartificial liver support system in treatment of HBV-related acute-on-chronic liver failure
文章发布日期:2013年08月06日  来源:  作者:游绍莉,刘鸿凌,辛绍杰,等  点击次数:1948次  下载次数:346次

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【摘要】:目的利用自行构建的混合型生物人工肝系统,探讨其治疗HBV相关慢加急性肝衰竭患者的安全性和有效性。方法采用转染人肝再生增强因子(hALR)的HepG2细胞为生物材料,构建中空纤维生物反应器。 以2009年5月-2011年8月住院的HBV相关慢加急性肝衰竭患者作为治疗对象,随机分为2组,每组10例,治疗组进行混合型生物人工肝治疗,对照组进行普通血浆置换治疗。两组间均数比较采用成组t检验,治疗前后比较采用配对t检验。结果治疗组10例患者中,7例经住院治疗临床好转出院,其余1例因肝性脑病死亡,1例因肝肾综合征死亡,1例出院后死于肝衰竭。对照组10例患者中存活5例,其余1例肝移植,4例因肝衰竭死亡。2组患者治疗前MELD评分分别为24.26±2.54及24.71±2.79,差异无统计学意义(t=1.971,P=0.064)。治疗组治疗3 d、1、4周MELD评分平均分别为21.71±2.92、22.10±4.46、19.90±5.43。跟踪随访1 a,治疗组和对照组患者血清甲胎蛋白平均值分别为14.24、11.32 ng/ml,腹部B超检查均未发现肝脏占位性病变。结论自行构建的混合型生物人工肝支持系统治疗HBV相关慢加急性肝衰竭患者具有一定安全性和有效性。
【Abstract】:ObjectiveTo construct a hybrid bioartificial liver support system and to investigate its safety and efficacy in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). MethodsA hollow fiber bioreactor was constructed using cultured HepG2 cells transfected with human augmenter of liver regeneration gene. Patients with HBV-related ACLF who were hospitalized in our hospital from May 2009 to August 2011 were randomly divided into treatment group (n=10) and control group (n=10). The treatment group was treated using the hybrid bioartificial liver support system, while the control group was treated with conventional plasma exchange. Comparison of means between the two groups was made by independent-samples t test, and comparison of variables before and after treatment was made by paired t test. ResultsOf the 10 patients in treatment group, 7 had improvement in clinical symptoms and were discharged, 1 died of hepatic encephalopathy, 1 died of hepatorenal syndrome, and 1 died of liver failure after discharge. Of the 10 patients in control group, 5 survived, 1 underwent liver transplantation, and 4 died of liver failure. Before treatment, the treatment group and control group had model for end-stage liver disease (MELD) scores of 24.26±2.54 and 24.71±2.79, respectively, without significant difference between the two groups (t=1.971, P=0.064). The treatment group had MELD scores of 21.71±2.92, 22.10±4.46, and 19.90±5.43 after 3 days, 1 week, and 4 weeks, respectively, of treatment. At the end of one-year follow-up, the mean serum alpha-fetoprotein levels were 14.24 ng/ml in treatment group and 11.32 ng/ml in control group, and no space-occupying lesions in the liver were found through abdominal ultrasound. ConclusionThe constructed hybrid bioartificial liver support system is effective and safe in the treatment of HBV-related ACLF.
【关键字】:肝功能衰竭;肝炎病毒,乙型;肝,人工;血浆置换
【Key words】:liver failure; hepatitis B virus; liver, artificial; plasma exchange
【引证本文】:

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