组合生物型人工肝治疗慢性重症乙型肝炎初步临床应用

目的　评估组合生物型人工肝治疗慢性重症乙型肝炎的临床疗效。方法　将KM880 0型血液净化仪与BIO LIVA3A型生物型人工肝机连接成组合生物型人工肝装置 ,对 4例晚期慢性重症乙型肝炎患者共实施 5例次治疗。先进行患者血液血浆置换 ,再经过生物型人工肝处理。观察患者治疗前、后的临床表现 ;比较肝功能各相关指标的变化 ,并比较血浆置换后、生物型人工肝处理后回路血中相应指标的变化。结果　本组患者治疗过程中生命体征平稳 ,除 1例次出现过敏反应外 ,未发生其它不良反应。与治疗前比较 ,治疗后即刻患者血中总胆红素 (TBIL)、丙氨酸转移酶 (ALT)、氨 (NH3)明显减少 (P <0 .0 1) ,高密度脂蛋白 (HDL)、纤维蛋白原 (FIB)明显增加 (P <0 .0 1) ,治疗后第 3天凝血酶原活动度 (PTa)明显提高 (P <0 .0 1) ;与血浆置换后比较 ,生物型人工肝处理后回路血中FIB有所增加 (P <0 .0 5 ) ,而NH3明显降低 (P <0 .0 1)。结论　应用组合生物型人工肝治疗慢性重症乙型肝炎是安全、有效的。组合生物型人工肝比单纯血浆置换疗效好

Preliminary Clinical Application of Hybrid Bioartificial Liver in Severe Chronic Hepatitis B

Objective To evaluate the efficacy of hybrid bioartificial liver in the treatment of the patients with sever chronic hepatitis B. Methods The hybrid bioartificial liver system consisted of KM8800 type plasma exchange device and A3A bioartificial liver apparatus were performed 5 times, which had been used in 4 cases with severe chronic hepatitis B. The patients were treated with plasma exchange then followed by bioartificial liver. The clinical manifestations and the serum indexes related to liver functions of the patients were observed and compared with that in different stages during the course of treatments. Results No significant changes of the vital signs were found and adverse effects except a case of allergy did not occurre in the patients during the treatment. Compared with that before treatment, the concentrations of blood total bilirubin, alanine transferase and NH 3 of the patients were much lower in immediality posttreatment(P<0.01), and levels of the high density lipoprotein and fibrinogen were much higher(P<0.01). In 3 days after the treatment, the level of prothromibine activity was much higher than that before treatment(P<0.01). Compared with that after the plasma exchange, the higher concentration of fibrinogen(P<0.05) and much lower NH 3(P<0.01) were found in the blood after the bioartificial liver treatment. Conclusion The treatment of hybrid bioartificial liver in sever chronic hepatitis B is safe and effective and superior over the efficacy with plasma exchange alone.