人工肝治疗对重型肝病患者生存期的影响

目的通过前瞻性、多中心、大样本的对照研究,探讨人工肝治疗对重型肝病患者生存期的影响。方法前瞻性地选择首都医科大学附属北京佑安医院等5家医院的重型肝炎和慢性肝炎重度(且凝血酶原活动度<50％)患者518例,将患者分为人工肝治疗组和常规内科治疗对照组,记录其诊断、分期等原始资料并进行随访,采用Kaplain-Maier方法进行生存情况分析。结果急性重型肝炎患者人工肝治疗组的中位生存期为(8．0±0．4)d,内科治疗对照组为(4．0±0．2)d,P=0．004。人工肝治疗2次以上疗效更加明显,它可使慢眭重型肝炎患者生存期由(27．0±1．6)d延长至(39．0±4．0)d,重型肝炎中期患者生存期由(38．0±17．5)d延长至(66．0±18．6)d;晚期患者生存期由(18．0±4．0)d延长至(26．0±2．5)d,差异均有统计学意义。结论人工肝治疗能够延长急性重型肝炎患者、慢性及亚急性重型肝炎中晚期患者的生存时间,多次治疗效果显著优于单次治疗和内科治疗。

Survival analysis on liver failure patients treated with an artificial liver support system

OBJECTIVE: To evaluate the efficacy of artificial liver support system (ALSS) in the treatment of liver failure patients. METHODS: This is a prospective, multi-center, controlled, large sample clinic trial. 518 patients with liver failure from 5 hospitals were studied and followed. All the patients received similar pharmacological manipulation according to one and the same protocol but were divided into an ALSS treatment group and a control group without ALSS treatment. The ALSS treatment procedures included plasma exchange, molecular adsorbent recirculating system (MARS), plasma exchange plus hemofiltration and other combined nonbioartificial methods. The analysis of survival time was computed using the Kaplain-Maier method, and comparison among groups was done using Log-Rank, Breslow and/or the Tarone-Ware test. RESULTS: Survival time of acute liver failure patients was prolonged from 4.0+/-0.2 days to 8.0+/-0.4 days (P=0.004). ALSS was shown to be two times more effective. ALSS increased the survival time of acute on chronic (A on C) liver failure patients from 27.0+/-1.6 days to 39.0+/-4.0 days (P less than 0.01). In addition, it increased the survival time of the patients in the middle and end stage of subacute liver failure and A on C liver failure, but had no significant effects on early stage patients. The survival time of middle stage patients was 38.0+/-17.5 days in the control group vs 66.0+/-18.6 days in the ALSS group (P less than 0.05). The survival time of end stage patients of the control group and the ALSS group was 18.0+/-4.0 days vs 26.0+/-2.5 days (P less than 0.01). CONCLUSIONS: Multi ALSS treatment is more effective than the standard medicinal liver care treatment. Multi-ALSS treatment could increase survival time of patients suffering from acute liver failure or A on C liver failure, especially in their middle and end stages. It is important and necessary to treat these patients with ALSS.