新型人工肝单纯白蛋白透析治疗肝衰竭的临床研究

目的 以人体白蛋白作为透析液进行血液透析，观察其对肝衰竭的疗效，并与分子吸附再循环系统（MARS）进行比较。方法 18例肝衰竭患者中12例行单纯白蛋白透析（SAD），6例行MARS，每次均为6h，根据病情，每日或隔日1次，连续治疗2～6次。SAD以4000ml白蛋白溶液（质量浓度45g／L）作为透析液，置于袋中封闭循环使用，血流量250ml／min，透析液流量10L／h。分别于治疗前后取血样，检测肝功能、肾功能、血氨、内毒素和凝血酶原活动度（PTA）；另于治疗1、3和6h时分别测定血清与白蛋白透析液中的胆红素水平，治疗的同时密切观察临床表现。结果 SAD治疗后，患者临床症状与体征改善，肝功能好转，血流动力学稳定，血压上升，并发症部分缓解，特别是肝性脑病明显改善，并且不良反应少，治疗有效率高；PTA显著提高（P〈0．05），血中尿素氮、肌酐、胆红素、胆汁酸、血氨和内毒素水平均明显下降（P均〈0．05），但胆红素清除速率随着时间延长也逐渐减缓；SAD（质量分数为4．5％的白蛋白）治疗肝衰竭的疗效与MARS组基本相同（P〉0．05），但前者操作更简便，成本更低。结论 SAD能清除蛋白结合毒素，改善临床症状和肝功能，其治疗肝衰竭的疗效肯定，简单方便，值得进一步临床研究。

A pilot study of using pure albumin as a dialysate in the treatment of liver failure

Objective To observe the effect of a new extracorporeal hepatic sup porthemodialysis with albuminbased dialysate on patient with liver failure, and to compare the result with that of molecular absorbent recycling system (MA RS). Methods Eighteen patients with liver failure were enrolled and treated intermitte ntly with artificial liver on the basis of conventional regime. Among them, 12 of them were treated with single albumin dialysis (SAD) for 6 hours each period, and 6 with MARS for 6 hours. During each session of SAD, 4 000 ml albumin based dialysate (45 g/L) was circulated in the dialysate route at a flow rate o f 10 L/h with the blood flow rate of 250 ml/min. Liver and renal function, prot hrombin activity (PTA), serum ammonia (NH_3), endotoxin were monitored before and after the treatment, and the serial bilirubin content was measured in the serum and the albumin dialysate of all patients respectively 1hour, 3hour, 6hour after the treatment with SAD. Results After treatment with SAD, the clinical symptoms and signs were improved and the hemodynamics were stabilized, complications were ameliorated partially, in particular hepatic encephalopathy was improved, with low incidence of adverse reaction, and the effective rate and survival rate were high. The serum PTA was increased obviously (P<0.05), and the serum blood urea nitrogen (BUN), serum creatinine (SCr), total bilirubin (TB), total bile acid (TBA), NH_3, endotoxin were decrea sed significantly (all P<0.05), and elimination of bilirubin slowed down gr adually. The results showed that SAD was as effective as MARS, with a lower cost, and simpler and more convenient than MARS. Conclusion Single albumin dialysis may elimi nate proteinbound and watersoluble hepatic toxins, improve clinical symptoms and liver function in the treatment of liver failure, and worth further clinical study.