CAJ | 학술논문

目的评价新型生物人工肝(BAL)在肝移植前应用的临床效果.方法 22例肝功能衰竭患者,分成2组:(1)BAL联合肝移植组(10例)在肝移植前24 h先接受BAL治疗,治疗时间为4 h;(2)单纯肝移植组(12例)仅接受肝移植.于BAL治疗前、后以及肝移植后抽取患者外周血监测血常规、肝功能、凝血功能等指标,观察患者临床症状及体征的变化,以判定BAL的治疗效果.检测患者血浆及反应器中IgG、IgM及补体溶血活性(CH50)的水平,外周血单个核细胞中猪内源性逆转录病毒DNA、猪特异性细胞色素B基因序列及逆转录酶的活性等,以评估BAL治疗的免疫学和病毒学安全性.记录两组肝移植手术成功率、手术时间、冷缺血时间、手术出血量及肝功能恢复情况.结果移植前BAL联合肝移植组患者接受BAL治疗后感觉良好,乏力、纳差、腹胀等症状有所缓解,肝性脑病减轻,肝功能、血清氨、凝血功能等实验室指标均有不同程度的改善,未发生不良反应,无猪内源性逆转录病毒感染,以及血浆IgG、IgM和CH50无明显变化.两组患者均成功接受改良背驮式肝移植,术中无死亡.两组的手术时间和冷缺血时间的差异均无统计学意义(P＞0.05),术中出血量的差异有统计学意义(P＜0.01).BAL联合肝移植组患者在肝移植后各个时间点转氨酶、胆红素、血清氨、凝血酶原时间和白细胞等指标较单纯肝移植组均有所改善(P＜0.01或P＜0.05).结论新型BAL能更好地改善肝功能衰竭患者术前状态,为肝移植赢得手术时机.
목적 평개신형생물인공간(BAL)재간이식전응용적림상효과.방법 22례간공능쇠갈환자,분성2조:(1)BAL연합간이식조(10례)재간이식전24 h선접수BAL치료,치료시간위4 h;(2)단순간이식조(12례)부접수간이식.우BAL치료전、후이급간이식후추취환자외주혈감측혈상규、간공능、응혈공능등지표,관찰환자림상증상급체정적변화,이판정BAL적치료효과.검측환자혈장급반응기중IgG、IgM급보체용혈활성(CH50)적수평,외주혈단개핵세포중저내원성역전록병독DNA、저특이성세포색소B기인서렬급역전록매적활성등,이평고BAL치료적면역학화병독학안전성.기록량조간이식수술성공솔、수술시간、랭결혈시간、수술출혈량급간공능회복정황.결과 이식전BAL연합간이식조환자접수BAL치료후감각량호,핍력、납차、복창등증상유소완해,간성뇌병감경,간공능、혈청안、응혈공능등실험실지표균유불동정도적개선,미발생불량반응,무저내원성역전록병독감염,이급혈장IgG、IgM화CH50무명현변화.량조환자균성공접수개량배타식간이식,술중무사망.량조적수술시간화랭결혈시간적차이균무통계학의의(P＞0.05),술중출혈량적차이유통계학의의(P＜0.01).BAL연합간이식조환자재간이식후각개시간점전안매、담홍소、혈청안、응혈매원시간화백세포등지표교단순간이식조균유소개선(P＜0.01혹P＜0.05).결론 신형BAL능경호지개선간공능쇠갈환자술전상태,위간이식영득수술시궤.
Objective To investigate the safety and therapeutic effects of the novel bioartificial liver (BAL) combined with liver transplantation in patients with liver failure.Method Twenty-two patients with liver failure were admitted.Ten of them were treated with the novel BAL 24 h before liver transplantation,while the rest 12 served as controls and received liver transplantation only.The clinical signs and symptoms,liver function,ammonia,coagulation function and complete blood count were evaluated before,during and after the treatment.Levels of xenoantibodies (IgG and IgM) were detected by ELISA kit.Titers of complement were quantified by CH50 kit.DNA in the collected PBMCs was extracted for PCR with PERV specific primers and the porcine specific primer Sus scrofa cytochrome B.The RT activity was detected as well.The operation related information was recorded,such as operation success rate,operative time,cold ischemia time,bleeding volume in operation and liver function.Result All treatment procedures were completed successfully without any adverse reaction.In the BAL group,the clinical symptoms such as acratia,anorexia and abdominal distension were improved,as well as the stage of hepatic encephalopathy and the results of experimental tests such as liver function,ammonia,and coagulation function.No PERV infection and no obvious changes of the IgG,IgM and CH50 levels were detected in patients" plasma.All patients were successfully bridged to modified pig-back liver transplantation and recovered.There were no differences in operative time and cold ischemia time (P＞0.05).However,bleeding volume was different in these two groups (P＜0.05).The liver function was improved significantly in BAL group than the control group after liver transplantation (P＜0.01).Conclusion The novel BAL could improve the internal environment of patients with liver failure,and enhance the safety and efficiency of liver transplantation.The novel BAL combined with liver transplantation could be an effective therapy for patients with liver failure.