【作者】 罗二平；

【导师】 甘建和；

【作者基本信息】 苏州大学 ， 内科学， 2002， 硕士

【摘要】 目的 通过对杂交型人工肝支持系统治疗重型肝炎的临床研究，探讨其临床治疗价值、适应症、组合模式。 方法 研究对象分为对照组、血浆置换组、杂交型人工肝治疗组。对照组仅接受综合基础疗法；血浆置换组接受综合基础疗法+血浆置换；杂交型人工肝治疗组分治疗1组、2组，按组合模式不同分别接受综合基础疗法+血浆灌流十生物型人工肝、综合基础疗法+血浆置换+血浆灌流+生物型人工肝。记录分离出的肝细胞的数量和活性，观察患者临床表现的改变及转归，检测治疗前后BIL-T、BIL-D、PT血氨等指标。 结果 每只乳猪收获肝细胞100～150g，细胞数为0.76～1.14x10¹⁰，活细胞占92％，体外培养12小时后活细胞占90％，治疗结束后活细胞占80％。 杂交型人工肝治疗组、血浆置换组患者在治疗后临床症状明显好转；血氨下降，昏迷程度减轻，杂交型人工肝治疗组肝性脑病苏醒率（50％）高于其它二组。杂交型人工肝治疗组、血浆置换组在治疗后患者肝功能好转（血清BIL-T、BIL-D、TBA低于治疗前，P＜0.05）；PTA治疗后高于治疗前，P＜0.05。其中杂交型人工肝治疗2组血清BIL-T治疗后明显低于治疗前，P＜0.01，与治疗1组相比，P值=0.03BIL-D／BIL-T治疗后高于治疗前，P=0.02，；杂交型人工肝治疗2组凝血酶原活动度明显增高（治疗前后比较P＜0.01），与对照组组间相比P=0.08；杂交型人工肝治疗2组晚期重型肝炎存活率40.0％，高于杂交型人工肝治疗1组（20.0％）、血浆置换组（25.0％）、对照组（0％）。 结论 1．以生物型人工肝为核心的杂交型人工肝支持系统具有肝脏的生物合成、代谢、解毒等功能；2．由血浆置换、血浆灌流和生物人工肝组成的杂交型人工肝支持系统的组合模式能充分替代肝脏功能，治疗过程安全有效，能提高晚期重型肝炎患者的存活率。更多还原

【Abstract】 Objective To investigate treatment value , adaptions andcombination mode of Hybrid Artificial Liver Support System by clinical study on its therapeutic result of severe hepatitis.Materials and Methods The patients were divided into control group , plasmapheresis group and hybrid artificial liver group. Control group received a combined hepatotheragy; Plasmapheresis group were given combined hepatotheragy + plasma-exchange; Hybrid artificial liver group accept combined hepatotheragy + plasma-irrigation + bioartificial liver or combined hepatotheragy + plasma-exchange + plasma-irrigation +bioartificial liver according to combination mode. The quantity and activity of acquired porcine hepatocytes were recorded as well as the changes of patients’ appearance. BIL-T, BIL-D, PT and blood NH3 were detected before and after therapy.Results The total yield of isolating hepatocytes reached to 100-150 g (0.76~1.14xl010) in each pig liver with the viability of 92%. The viability decreased to 90% after 12 hour-culture and 80% after 9 hour-therapy of hybrid artificial liver.Symptoms of patients in hybrid artificial liver group, plasmapheresis group improved spontaneously; Severity of coma decreased as well as levels of plasma NH3, 50% patients in hybrid artificial liver group who were in the state of coma before the treatment regained consciousness. After each treatment, the liver function of these patients in hybrid artificial liver group, plasmapheresis groups was greatly improved(The serumBIL-T, BIL-D, TBA were lower than that before therapy, P<0.05 ); PTA was higher than that before therapy. The serum BIL-T of patients in Group 2 of hybrid artificial liver significantly decreased, P<0.01 (P = 0.03 ,compared Group 1);BIL-D/ BIL-T was higher than that before therapy, P=0.02; PTA was higher than that before therapy (P<0.01) .There was difference on PTA between Group 2 and control group. Patients in the end stage of disease in Group 2 had much higher survival rates(40%) than patients in other groups.Conclusion: 1. Hybrid artificial liver based on bioartificial liver has liver functions. 2. Hybrid artificial liver composed by plasma-exchange , plasma-irrigation and bioartificial liver may be a safe and efficacious method to provide liver support for patients in end stages with severe hepatitis, could rise their survival rate.更多还原