生物人工肝的研究与进展

目的:分析近些年来生物人工肝相关的研究,对生物人工肝的发展作一总结.资料来源:以bioartificial liver, liver cell, hepatocyte culture, bioreactor为检索词,检索Ovid、SpringerLink数据库(1990-09/2008-09);以生物人工肝、肝细胞、细胞培养、生物反应器为检索词,检索维普数据库、中国期刊网及万方数据库(1990-09/2008-09).文献检索语种限制为英文和中文.资料选择:纳入有关生物人工肝肝细胞、反应器及辅助装置的研究,排除生物人工肝免疫和动物传染的研究.结局评价指标:①生物人工肝肝细胞的来源、数量及培养方式.②生物反应器的类型及主要结构膜的性质及类别.③生物人工肝供氧及温控装置的构成.结果:计算机初检得到3 898篇文献,根据纳入排除标准,对29篇进行分析.生物人工肝是在体外生物反应器中培养肝细胞,当患者的血液流经生物反应器时,通过半透膜或直接接触的方式与培养的肝细胞进行物质交换,使其中的肝细胞发挥解毒、合成、生物转化等功能,以达到支持和治疗目的.它不但具有解毒功能,而且还能参与3大营养物质代谢,分泌促进肝细胞生长的物质等,可有效替代肝脏的解毒功能和合成功能,并可较好地预防肝性脑病、肝昏迷和脑水肿,临床上可作为肝衰竭患者肝移植前的过渡辅助措施.结论:生物人工肝研究虽然取得了重大进展,但仍然面临寻找理想肝细胞来源,长期维持肝细胞的活性和功能,进一步优化反应器设计等问题.

Research progress of bioartificial liver

OBJECTIVE: To analyze the research literatures related to bioartificial liver, and to make a conclusion concerning the development of bio-artificial liver.DATA SOURCES: Using bioartificial liver, liver cell, hepatocyte culture and bioreactor as search terms, searching Ovid, Springer Link database, and China National Knowledge Infrastructure, Vip Information database and Wanfang Date (1990.09-2008.09). Literatures search was limited to English and Chinese languages.DATA SELECTION: Researches regarding liver cells of bioartificial liver, reactors and auxiliary equipment was included, and the studies about immune and animal infection studies of bioartificial liver were excluded.MAIN OUTCOME MEASURES: ①The source, quantity and culturing of bio-artificial liver hepatocytes. ②Bioreactor type, nature and type of films. ③Composition of oxygen and temperature control devices of bioartificial liver.RESULTS: Totally 3898 documents seized initially in the searching by computer, according to inclusion and exclusion criteria, 29 were analyzed. Bioartificial liver was a hybrid device in which can culture hepatocytes in vitro, when the patient's blood flows through the device, material exchange with the cultured hepatocytes through semi-permeable membrane or direct contacting can take place, which can perform the same roles of detoxification, synthesis, biological transformation and other functions as real liver cells, so as to achieve the purpose of support and treatment. Bioartificial liver can also be involved in metabolism of the three major nutritive substances, as well as secretion of hepatocyte growth promo ting substances. So it is an effective alternative to the real liver as the function of detoxification and synthesis, and can fills the essential gap between the transplantation and acute liver failure.CONCLUSION: Although the bioartificial liver research has made significant progress, it still faces the problems such as limited liver cells sources, long-term maintenance of liver cell activity and function, and further optimization of the reactor design.