【作者】 张跃新； 孙丽华； 肖琳； 鲁晓擘；

【Author】 Zhang Yue-xin Sun Li-hua Xiao Lin Lu Xiao-bo,Special Hospital for Liver Disease First Affiliated Hospital,Xin Jiang Medical University,WuLuMuQi 830054,China

【机构】 新疆医科大学第一附属医院肝病中心；

【摘要】 目的评价分子吸附再循环系统(MARS)治疗重型肝炎的临床疗效,应用终末期肝病评分模型(MELD),观察它对重型肝炎预后的预测作用。方法 27例重型肝炎患者在内科综合治疗基础上进行了49次 MARS 治疗,观察所有患者3个月内临床转归。结果①MARS 明显降低白蛋白结合毒素(如胆红素、胆汁酸)和水溶性毒素(如肌酐),改善肝、肾功能。②MARS 可改善凝血功能,凝血时间的国际标准化比率(INR)显著降低(P<0.05)。③除 MELD 分值≥40分组的预期病死率和实际病死率相同外, 其余各分组均显示 MARS 可降低3个月预期病死率,降低平均 MELD 分值(P<0.01),改善预后,治疗后总存活率为48.1%。结论 MARS 是对治疗重型肝炎有肯定价值,对 MELD<40分以下者具有明显的改善预后作用。MELD 评分对重型盱炎预后有预测作用,有临床实用价值。更多还原

【Abstract】 Objective to evaluate the efficiency of Molecular Adsorbents Recycling System (MARS) in the treatment of severe hepatitis and to study the clinical use of the Model for End-Stage Liver Diease (MELD) .Method 27 patients with severe hepatitis were treated with MARS 49 times combined with standard medical treatment .All of the patients graded with MELD and the mortality were observed three months later.Results MARS therapy achieved significant decrease in albumin bound toxins and water soluble toxins,together with significant decrease the International Normalized Ratio (INR) for prothrombin time. For the patients with MELD less than 40,the reality death rate remarkably decreased.After MARS treatment,overall survival rate of 3-month was 48.1%;MARS treatment results in significant decrease of the average MELD score.Conclusion MARS is a useful way for therapy of severe hepatitis:MELD can be applied in clinic for evaluating severity of severe hepatitis and effect of MARS;MARS can be used safely and efficiently to treat end-stage liver disease with MELD score less than 40.更多还原