BL-300型灌流柱对慢性重型肝炎患者血浆的净化作用

目的观察BL-300型灌流柱对慢性重型肝炎患者血浆生化物质浓度的影响。方法收集慢性重型肝炎患者血浆置换治疗时换出血浆8.4L,混合后均分为3份分别经BL-300型灌流柱循环灌流,检测灌流前与循环灌流后总量达32.0L时总胆红素（TBIL）、直接胆红素（DBIL）、胆汁酸（TBA）、白蛋白（ALB）、球蛋白（GLB）、丙氨酸转移酶（ALT）、尿素氮（BUN）、胆固醇（CHOL）、胆碱酯酶（CHE）和葡萄糖（GLU）各值,以及循环灌流后总量分别达0.5L、1.0L、2.0L、4.0L、8.0L、16.0L、32.0L时TBIL廓清率和DBIL廓清率;选择TBIL在300μmol/L以上的慢性重型肝炎患者65例,建立桡动脉-肘正中静脉或股静脉单针双腔静脉导管置管的循环通路,并将PS-06型中空纤维型血浆分离器和BL-300型灌流柱串联处理患者血浆,检测灌流前与循环灌流后总量达6.0L时上述各指标值。结果混合血浆经柱循环灌流后总量达32.0L时,与灌流前比较,TBIL、DBIL和TBA的浓度均明显降低（P〈0.01）,下降幅度分别约为58.1%、54.9%和86.9%,被吸附总量分别约为342.2μmol、292.3μmol和263.5μmol,ALb和GLB（P〈0.05）下降幅度分别约为7.5%和11.7%,被吸附总量分别约为7.0g和9.5g,其他检测指标无明显变化;在循环灌流后总量达8.0L前,TBIL廓清率和DBIL廓清率均维持较高的水平,超过8.0L后两者明显减低,超过16.0L时则持续处于低水平值。本组患者在体血浆循环灌流后总量达6.0L时,TBIL、DBIL和TBA浓度比灌流前均明显下降（P〈0.01）,下降幅度分别约为51.5%、52.3%和57.8%。而血浆ALb、GLB浓度略有降低,其它检测指标及指征无变化。结论BL-300型灌流柱对慢性重型肝炎患者血TBIL、DBIL和TBA有较强的吸附作用,但该作用在循环灌流后总量达到一定量时会出现饱和效应,且用于人工肝治疗时需注意补充ALB和GLB。

The effect of BL-300 perfusion column on plasma purification for patients with chronic severe hepatitis

Objective To observe the effect of BL-300 perfusion column on clearance of biochemical substances in plasma for patients with chronic severe hepatitis. Methods Mixed plasma collected from patients with chronic severe hepatitis flowed through BL-300 perfusion column in cycles. Serum biochemical substances including total bilirubin （TBIL）, direct bilirubin （DBIL）, bile acid （TBA）, albumin （ALB） and globulin （GLB） were tested before the perfusion and after the pass-through reached 32.0 liters. The clearance rate of TBIL and DBIL was calculated when the total amount of pass-through was 0, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0 and 32.0 liters, respectively. We also observed the changes of these serum biochemical parameters in 65 patients with chronic severe hepatitis treated with hemoperfusion using the BL-300 perfusion column. Results When the total amount of pass-through reached 32.0 liters, TBIL, DBIL and TBA in the mixed plasma decreased significantly （P〈0.01, as compared with those in the plasma prior to perfusion）, and ALB and GLB （P 〈 0.05） decreased slightly. TBIL concentration decreased by 58.1%, DBIL by 54.9%, TBA by 86.9%, ALB by 7.5% and GLB by 11.7%, corresponding to the total adsorbed amount of 342.2 μmol, 292.3 μmol, 263.5μmol, 7.0g and 9.5g, respectively. The clearance rate of TBIL and DBIL of the mixed plasma decreased gradually with the increase of total amount of pass-through. In patients with chronic severe hepatitis after perfusion with BL-300 perfusion column, serum biochemical parameters showed the same changes as those of the mixed plasma. No other abnormal changes were found in this study. Conclusion BL-300 perfusion column is effective in adsorption of serum TBIL, DBIL and TBA in patients with chronic severe hepatitis. Supplement of ALB and GLB is necessary to the patients treated with artificial liver of this column.