连续性树脂血浆灌流吸附治疗肝病性高胆红素血症13例报道

目的观察树脂血浆灌流吸附治疗13例肝病性高胆红素血症患者的疗效。方法13例肝病性高胆红素血症患者（rIBiL≥171μmol／L），采用连续性HB—H-6树脂血浆灌流吸附治疗。观察胆红素变化情况及对血压、心率、呼吸和体温的影响。结果灌流前与灌流后相比，血浆总胆红素下降53％，直接胆红素下降49％，间接胆红素下降66％；血压、心率、呼吸和体温没有明显变化。结论树脂血浆灌流吸附治疗肝病性高胆红素血症是一种安全有效的方法。     

HB-H-6树脂血浆灌流治疗重度黄疸初步临床研究

目的研究HB-H-6树脂吸附胆红素血浆灌流对重度黄疸的治疗效果。方法重度黄疸患者76例,其中男性61例,女性15例,年龄41～75岁,平均59岁。均为急慢性肝功能衰竭、重型肝炎造成的肝细胞性黄疸和肿瘤、结石等阻塞胆管而造成的梗阻性黄疸,其中肝细胞性黄疸70例,梗阻性黄疸6例。总胆红素(TBiL)(359±138)μmol/L,直接胆红素(I鄄BiL)(132±76)μmol/L,间接胆红素(DBiL)(227±97)μmol/L;总蛋白(TP)(64±12)g/L,白蛋白(Alb)(28±11)g/L,球蛋白(Glb)(36±13)g/L。采用一次性使用HB-H-6树脂吸附胆红素血浆灌流器进行治疗。分别于灌流前、灌流120min取血测定血浆胆红素、蛋白质、电解质、血常规,定时观察患者血压、心率、体温和呼吸变化。结果灌流至2h结束,总胆红素下降29%,直接胆红素下降27%,间接胆红素下降30%;总蛋白下降11%,白蛋白下降14%,球蛋白下降8%;灌流对血浆电解质钾、钠、氯、钙、镁和磷均无明显影响(P>0.05)。灌流前后相比,白细胞升高2%,红细胞下降1%,血小板降低6%(P>0.05)。灌流过程中,患者心率、血压、体温和呼吸等生命指标均无明显变化。结论HB-H-6树脂血浆灌流治疗重度黄疸是一种安全、有效的方法,其血浆灌流器很有发展前途。     

肝硬化顽同性腹水净化回输的临床研究

目的利用血液透析原理对腹腔积液患者进行自体腹腔积液净化回输治疗。方法58例肝硬化顽固性腹水（RA）为研究对象，从腹腔一侧抽出腹腔积液，净化后回输至对侧。结果58例RA患者于腹腔积液净化回输后，腹围、体重显著下降（P〈0．05）；尿量、血浆蛋白显著增加（P〈0.05），腹腔积液减少或消失。结论利用血液透析原理进行自体腹腔积液净化回输技术疗效确切，经济，简便。     

HB-H-6树脂吸附胆红素血浆灌流治疗慢性肝病重度黄疸适用范围

目的进一步评价HB-H-6树脂吸附胆红素血浆灌流在治疗慢性肝病重度黄疸中的价值及最佳适用范围。方法选择2006年10月～2010年7月天津市第三中心医院94例不同病因慢性肝病重度黄疸患者,其中男性68例,女性26例;年龄29～76岁,中位年龄57岁。接受HB-H-6树脂吸附胆红素血浆灌流治疗,比较单次HB-H-6树脂吸附胆红素血浆灌流治疗前后血清胆红素变化;并探讨不同初始胆红素水平及初始凝血酶原活动度(PTA)水平对HB-H-6树脂吸附胆红素能力的影响。结果单次HB-H-6树脂吸附胆红素血浆灌流治疗前血清总胆红素(TBiL)、直接胆红素(DBiL)、间接胆红素(IBiL)分别为(387.80±183.08)、(238.66±103.52)、(127.23±62.00)μmol/L;治疗后分别为(291.80±135.58)、(183.10±76.29)、(92.85±54.25)μmol/L,血浆灌流治疗能显著降低治疗后血清TBiL、DBiL及IBiL的水平(P<0.01);单次HB-H-6树脂吸附胆红素血浆灌流治疗对TBiL、DBiL及IBiL的清除率分别为23.68%±9.14%、21.54%±9.90%及27.09%±16.84%,HB-H-6树脂对IBiL的吸附能力略强于TBiL及DBiL(P<0.01)。HB-H-6树脂吸附胆红素血浆灌流对不同层次的初始TBiL水平均有效,均能引起治疗后胆红素水平的显著降低(P<0.01);初始TBiL水平越高,HB-H-6树脂清除胆红素的绝对值越高(P<0.01);对初始TBiL水平在200μmol/L以上HB-H-6树脂吸附能力明显高于初始TBiL水平在200μmol/L以下时(P<0.01)。HB-H-6树脂吸附胆红素的能力不受初始PTA影响;无明显不良反应。结论 HB-H-6树脂吸附胆红素血浆灌流作为黄疸的人工肝治疗方法之一,安全有效,且适用于TBiL浓度200μmol/L以上的重度黄疸患者。     

双重腹水超滤浓缩腹腔回输治疗肝硬化合并自发性细菌性腹膜炎患者的临床疗效观察

目的观察应用双重腹水超滤浓缩腹腔回输术治疗肝硬化合并自发性细菌性腹膜炎腹水的临床效果及安全性。方法选择60例肝硬化合并自发性细菌性腹膜炎患者,其中男性54例,女性6例;年龄36～76岁,平均年龄53.4岁。在内科药物治疗基础上增加双重腹水超滤回输治疗,分别于治疗前后观察患者临床症状、腹围、治疗当天尿量、24h尿量、血清尿素和肌酐、血清电解质、血清蛋白等指标的变化及治疗前后患者并发症发生情况。结果患者治疗后乏力、纳差、腹胀不适症状明显改善56例（56/60）,腹围均明显缩小;同治疗前比较,治疗当天尿量及24h尿量均增加（P〈0.05）;治疗后患者血清尿素和肌酐有所下降,但与治疗前比较均无统计学意义（P〉0.05）,治疗前后血清电解质差异亦无统计学意义（P〉0.05）;治疗结束后腹水蛋白浓度[（16.4±5.6）g/L]明显高于治疗前[（8.4±3.2）g/L],差异有统计学意义（t=27.2,P〈0.01）;60例患者出院时的转归中,好转42例,无效12例,死亡6例,总有效率70.0%。并发症发生情况：术后出现头晕、乏力明显2例,肝区隐痛不适2例,无肝性脑病、消化道出血等严重并发症发生。结论双重腹水超滤浓缩腹腔回输治疗肝硬化合并自发性细菌性腹膜炎患者是安全有效的,且简便易行。     

用HB-H-6树脂吸附胆红素血浆灌流器治疗76例重度黄疸的临床报告

笔者于2004年至2006年使用天津市紫波公司生产的一次性使用HB-H-6树脂吸附胆红素血浆灌流器(以下简称灌流器)用于治疗重度黄疸76例,取得良好疗效,现总结如下。材料和方法患者76例,其中男61例,女15例,年龄41～75岁,均为药物中毒等致急慢性肝功能衰竭及重型肝炎造成的肝细胞性黄疸和肿瘤、结石等阻塞胆管而造成的梗阻性黄疸患者。灌流器使用紫波公司生产的一次性使用HB-H-6树脂吸附胆红素血浆灌流器,灌流器内填充树脂330 ml±10 ml。灌流方法采用血浆灌流,全血流速为150～200 ml／min,血浆流速为20-25 ml／min,肝素总用量为40～55 mg,灌流结束前静脉推入鱼精蛋白50 mg。     

腹水浓缩回输治疗肝炎后肝硬化顽固性腹水

应用自体腹水浓缩回输治疗１２０例肝炎后肝硬化顽固性腹水，并对影响疗效的７２项因素做了单因素及多因素分析，认为主要与肝功能情况及合并症关系密切。本组患者经腹水回输迅速解除了腹水压迫缓解了病情，使利尿剂能充分发挥作用并能改善体内某些激素代谢，其总有效率为６８．３４％，较长地延长了患者的生命部分患者已重新走上工作岗位。     

用HB—H-6树脂血浆灌流器治疗重度黄疸效果好

贵阳医学院附属医院感染科于2005年8月～12月使用由天津市紫波高科技有限公司生产、北京伟力新世纪科技发展有限公司经销的一次性使用HB—H-6树脂吸附胆红素血浆灌流器对10例重型肝炎伴高胆红素血症患者进行血浆灌流吸附胆红素治疗，取得良好疗效。     

自体细胞因子诱导杀伤细胞治疗HBV感染肝硬变患者的临床疗效分析

目的观察自体细胞因子诱导杀伤细胞(CIK细胞)治疗HBV DNA阳性肝硬化患者的近期疗效。方法33例HBV DNA阳性肝硬化患者给予CIK细胞治疗,在体外培养前后以及回输体内后检测CD3 、CD3 CD4 、CD3 CD8 、CD3 CD56 、CD25 细胞以及mDC和pDC。比较治疗前后病毒学指标及肝脏功能的变化。结果培养结束以及回输体内后,CD3 细胞、CD3 CD8 细胞、CD3 CD56 细胞较培养前显著升高,mDC和pDC在回输后也明显增高。12例患者HBV DNA阴转,4例患者拷贝数下降大于2个log。在14例HBeAg阳性患者中有10例阴转,2例出现HBeAb转换。肝脏功能较治疗前有所好转。所有患者均能耐受治疗。结论CIK细胞可明显提高免疫效应细胞数量,具有一定的抗病毒效应作用,毒副作用低。     

血浆灌流治疗高胆红素血症的临床研究

目的 观察使用树脂通过血浆吸附(PA)胆红素治疗肝性高胆红索血症的疗效和安全性.方法 选择临床肝性高胆红素血症患者19例,其中男性18例,女性1例;年龄28～63岁.平均年龄45.5岁.病毒性肝炎乙型亚急性重型11例,慢性重型4例,戊型2例,丙型2例.观察PA治疗前后胆红素变化及临床症状改善情况,评价PA的疗效和安全性.结果 PA术后总胆红素(TBiL)较术前明显下降,吸附率为13.0%～31.2%,不良反应发生率为18.0%(血压下降2例,占9.0%;出血2例,占9.0%).结论 树脂通过PA治疗肝性高胆红素血症有较满意的疗效和较高的安全性,可明显改善患者临床症状及缩短平均住院时间.     

A case of alcoholic cirrhosis demonstrating long-term poor-visualization of the hepatic image on 99mTc-phytate scintigraphy

A 27-year-old female patient with alcoholic cirrhosis was reported. She was admitted to the hospital because of jaundice and ascites after heavy drinking. She had a history of drinking Japanese Sake in quantities of more than 5 go/day (900 ml/day) for 7 years. On admission, she was icteric, and had both hepatosplenomegaly and ascites. Laboratory data showed an elevation of serum transaminase and bilirubin, and a decrease in the albumin and prothrombin values. A biopsy specimen of the liver showed pericellular fibrosis, fatty change, Mallory bodies and regenerative nodules, and revealed findings compatible with alcoholic cirrhosis. A 99mTc-N-pyridoxyl-5-methyltryptophan scintigram showed hepatomegaly. On the 99mTc-phytate scintigram, the uptake of radioisotope to the liver was markedly decreased with the increased uptake to the spleen and bone marrow. Even 6 months after the onset, poor visualization of the hepatic image on 99mTc-phytate scintigram continued. This is the first report of alcoholic cirrhosis demonstrating a long-term poor visualization of the hepatic image on 99mTc-phytate scintigraphy.     

单纯光疗或光疗联合白蛋白治疗足月新生儿重度黄疸的效果分析

目的:分析非换血治疗(包括单纯光疗和光疗联合白蛋白治疗)对足月新生儿重度黄疸的治疗效果。方法:回顾分析110例接受单纯光疗或光疗联合白蛋白治疗、血清总胆红素水平342μmol/L的足月新生儿。观察患儿血清胆红素水平变化及神经系统体征。结果:单纯光疗组和光疗联合白蛋白治疗组患儿在治疗第1天后及出院时其血清总胆红素及间接胆红素水平均显著下降(P0.01)。光疗联合白蛋白治疗组患儿较单纯光疗组患儿出院时血清总胆红素及间接胆红素水平降低程度更高。所有患儿入院及出院时均未发生胆红素脑病。结论:单纯光疗和光疗联合白蛋白治疗均可以有效治疗足月新生儿重度黄疸,预防急性胆红素脑病。     

Biochemical assessment and clinical evaluation of a non-ionic adsorbent resin in patients with intractable jaundice

We investigated in vitro and in vivo the ability of a non-ionic adsorbing resin (styrenedivinylbenzene copolymer) to remove bilirubin and bile acids from human plasma. In preliminary experiments, human plasma from healthy donors, enriched in conjugated bile acids and bilirubin, and pooled plasma from jaundiced patients were recirculated through the resin column. The removal of bilirubin and bile acids was evaluated at two different flow rates (200 ml/min and 40 ml/min), and compared to an activated charcoal column. Four patients with severe jaundice were subsequently treated by 4-hour plasmaperfusion through the resin. The in vitro studies showed that after 1 hour the removal of bile acids was almost complete and bilirubin level decreased significantly, reaching a plateau after 4 hours. In the in vivo study, all treatments were well tolerated. After plasmaperfusion, serum bile acid levels decreased by 64.9-94.6% and total bilirubin by 35.3-57.7%. No clinical or biochemical side effects were observed. Our data suggest that plasmaperfusion through this resin is safe and efficient for removal of bilirubin and bile acids in jaundiced patients. Thus, it may serve as a method of artificial liver support in the treatment of cholestatic syndromes.     

Biochemical assessment and clinical evaluation of a bilirubin adsorbent column (BR-350) in critically ill patients with intractable jaundice.

We investigated the efficacy of an anion-exchange adsorbent column (ASAHI BR-350, DIAMED) for removal of bilirubin and bile acids in five patients with intractable jaundice of various origin. Four litres of plasma were separated by membrane plasma separation (Plasmaflow OP-05) at a rate of 22.5 ml/min. The plasma was then perfused through an anion exchange adsorbent and returned to the venous blood line of the plasma separation. In some of the patients this procedure was combined with regular hemodialysis treatment. The concentration of total bilirubin was cut by 31 to 60%; total bile acids were reduced by 20 to 74%. Three patients recovered and had a favourable outcome. Two patients died despite the bilirubin adsorption treatment. The effects of the adsorbent column on specific blood parameters, including the coagulation system, were measured. Our data suggest that bilirubin adsorption should be examined further as a treatment for critically ill patients with intractable jaundice.     

Occlusive portal vein thrombosis as a new marker of decompensated cirrhosis

Natural history of liver cirrhosis is divided into compensated and decompensated stage. Traditionally, the markers of decompensated cirrhosis include ascites, variceal hemorrhage, hepatic encephalopathy and jaundice. The clinical importance of portal vein thrombosis (PVT) is increasingly recognized in patients with liver cirrhosis. The presence of PVT is not only an independent predictor of failure to control active variceal bleeding and prevent variceal rebleeding, but also significantly associated with increased mortality in patients with liver cirrhosis. Besides, it greatly influences the technical success and outcome of endovascular interventional treatment and liver transplantation for liver cirrhosis and its secondary portal hypertension. Thus, we hypothesize that PVT should be regarded as a critical marker of decompensated cirrhosis, whether clinical events such as the development of ascites, encephalopathy, and variceal bleeding occur or not. Our hypothesis adds PVT into the definition of decompensated cirrhosis and reminds clinicians and investigators that PVT plays a vital role in natural history of liver cirrhosis. Further, it is essential to construct a new system of preventing and treating liver cirrhosis in the presence of PVT.     

Fibrosing cholestatic hepatitis: a report of three cases

Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We report three cases of fibrosing cholestatic hepatitis in various clinical situations. Case 1 was a 50-year-old man who underwent a liver transplant for hepatitis B virus (HBV)-associated liver cirrhosis. Two and a half years after the transplant, he complained of fever and jaundice, and liver enzymes were slightly elevated. Serum HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppressed state after chemotherapy for acute lymphoblastic leukemia. He was a HBV carrier. Liver enzymes and total bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent renal transplantation as a known HBV carrier. One year after the transplant, jaundice developed abruptly, but liver enzymes were not significantly elevated. Microscopically lobules were markedly disarrayed, showing ballooning degeneration of hepatocytes, prominent pericellular fibrosis, and marked canalicular or intracytoplasmic cholestasis. Portal inflammation was mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for HBsAg and HBcAg in various patterns. Patients died of liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.     

Serum interferon-gamma-inducing factor/IL-18 levels in primary biliary cirrhosis

Primary biliary cirrhosis is an autoimmune disease of the liver in which T helper 1 cytokines predominate over those of T helper 2 in the pathogenesis. Interleukin- 18 (IL-18), for which the gene was recently cloned, is a novel T helper 1 cytokine, which augments interferon-gamma production. We designed this study to clarify the role of IL-18 in primary biliary cirrhosis and to examine whether serum IL-18 level can be a prognostic indicator for the disease. Serum IL-18 levels were measured using an enzyme linked immuno sorbent assay with mouse monoclonal antibodies. Twenty-two healthy volunteers, 31 patients with primary biliary cirrhosis (Scheuer's stage I, 13; II, 10; and IV, 8), 20 patients with autoimmune hepatitis, 11 patients with virus-related liver cirrhosis and six patients with obstructive jaundice were enrolled. Significant differences of serum IL-18 levels were observed between patients with Scheuer's stage IV and those with stage I, or II, virus-related liver cirrhosis and obstructive jaundice (P < 0.05). The IL-18 levels in primary biliary cirrhosis increased according to the disease progression, and fell promptly after living-related liver transplantation. Moreover, serum IL-18 levels in primary biliary cirrhosis were correlated with serum bilirubin concentrations and the Risk scores of the Mayo Clinic prognostic model for the disease. The IL-18 levels observed in patients with autoimmune hepatitis were also elevated, and correlated with the activity of the disease. These results indicate that serum interleukin-18 levels reflect the severity of primary biliary cirrhosis, the activity of autoimmune hepatitis, and may be an additive prognostic indicator in primary biliary cirrhosis.