摘要
目的以人体白蛋白作透析液行血液透析(AD),观察其对重型肝炎的疗效,并与血浆置换(PE)、血液灌流(HP)和分子吸附再循环系统(MARS)进行比较。方法60例重型肝炎患者在一般治疗基础上行人工肝治疗,16例行AD,17例行PE,14例行HP,13例行MARS;根据病情,每例患者治疗2～4次。AD以4000ml质量浓度4.5%白蛋白溶液作透析液,封闭循环使用。各组患者分别于治疗前、后取血样,检测肝功能、肾功能、内毒素和炎症因子水平等,同时密切观察临床表现。结果AD治疗后,血总胆红素(TBiL)、总胆汁酸(TBA)、氨(NH3)、尿素氮(Bun)、肌酐(Cr)、内毒素(ET)、一氧化氮(NO)、肿瘤坏死因子(TNF-α)和白细胞介素-6(IL-6)浓度明显下降(P<0.05);凝血酶原活动度(PTA)显著上升(P<0.05);患者临床症状与体征改善,血流动力学稳定,不良反应少,治疗有效率高,综合疗效优于PE组和HP组,并且因价廉、简便也胜于MARS组。结论白蛋白透析能清除水溶性和蛋白结合性毒素及炎症介质,改善临床症状和肝功能,其治疗重型肝炎疗效肯定,简单方便,值得进一步推广使用。
Objective To evaluate the effect of a novel blood purification approach[hemodialysis with albumin-based dialysate or albumin dialysis （AD）] on severe hepatitis, and compare that with plasma exchange（PE）, hemoperfusion（HP） and molecular absorbent recycling system（MARS）. Methods Sixty patients with severe hepatitis gravis were enrolled and treated with artificial liver on the basis of conventional therapy, 16 with A D, 17 with PE, 14 with HP and 13 with MARS. During the process of A D, 4 000 ml albumin-based dialysate （4.5 % albumin） was circulated in the dialysate route. Hepatic and renal function,level of prothrombin activity （PTA）, inflammatory factors were monitored before and after treatment in all of the patients. Results After treating with AD, the levels of TBiL, TBA, N H3, Cr, ET, NO, TNF-α, IL-6 decreased si gnicantly （P 〈 0.05 ）, PTA increased （P 〈 0.05）. The clinical symptoms and signs of patients were improved, their hemodynamics were stabilized. The higher effective rate and the lower incidence of adverse reaction were found. Conclusion The AD may significantly eliminate the hepatogenic toxin and pathogenic components,improve clinical symptoms and liver function. It is more effective than PE or HP, simper and more convenient than MARS in the treatment of severe hepatitis with lower expense, and valuable to spread its clinical application.
出处
《生物医学工程与临床》
CAS
2006年第2期85-88,共4页
Biomedical Engineering and Clinical Medicine
关键词
白蛋白透析
重型肝炎
人工肝
血液净化
albumin dialysis
severe hepatitis
artificial liver
blood purification
