Evaluation on Efficacy of Non-biological Artificial Liver in Treatment of Liver Failure

Zhang Le; Yue Yun Xuan; Xia Jia Wei; Peng Jing; Li Hui; Tang Li Bin

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Article Navigation > Journal of Kunming Medical University > 2017 > 38(01): 82-87

Zhang Le , Yue Yun Xuan , Xia Jia Wei , Peng Jing , Li Hui , Tang Li Bin . Evaluation on Efficacy of Non-biological Artificial Liver in Treatment of Liver Failure[J]. Journal of Kunming Medical University, 2017, 38(01): 82-87.

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Zhang Le , Yue Yun Xuan , Xia Jia Wei , Peng Jing , Li Hui , Tang Li Bin . Evaluation on Efficacy of Non-biological Artificial Liver in Treatment of Liver Failure[J]. Journal of Kunming Medical University, 2017, 38(01): 82-87.

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Evaluation on Efficacy of Non-biological Artificial Liver in Treatment of Liver Failure

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基金：云南省科技厅应用基础研究基金资助项目 (2013FZ226); 云南省省院共建肝病重点专科建设基金资助项目 (云卫医发〔2015〕18号); 昆明市感染性疾病血液净化中心建设基金资助项目 (昆卫办〔2016〕115号);

Received Date: 2016-10-11

Abstract

Abstract

Objective To explore the efficacy of different non-biological artificial liver supporting system on liver function failure by retrospective study.Methods One hundred and six patients with liver failure were selected, who were diagnosed in the Third People's Hospital of Kunming City from January, 2014 to January, 2015, and during this period 240 person-time of the artificial liver treatment were completed.The patients weredivided into two groups according to the types of artificial liver, 62 patients in plasma exchange group (referred as PE) , 44 patients in plasma exchange combined with hemodiafiltration group (referred as PE+HDF) .Before and after the artificial liver treatment, we recorded the artificial liver laboratory indexes of the patients and model for end-stage liver disease (MELD) score, so as to evaluate the efficacy of two groups of treatment.Results (1) For these two groups, after treatment, the serum total bilirubin (TBIL) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) , total bile acid (TBA) levels were significantly reduced, and the difference was statistically significant (P<0.05) ; (2) Total bilirubin and bile acid clearance rate after artificial liver treatment was equal to 1-after treatment before treatment, compared with the group of PE, total bilirubin and bile acid clearance rate of PE+HDF group was higher, and the difference was statistically significant (P<0.05) .After PE treatment, the clearance rates of total bilirubin and bile acid were 54.07±11.03% and 85.95±30.22% respectively;after PE+HDF treatment, the clearance rates of total bilirubin and bile acid were 63.03±11.15% and 92.40 ±40.13% respectively; (3) After treatment, prothrombin activity (PTA) index significantly increased and International Normalized Ratio (INR) value decreased both in PE group and PE+HDF group, and the difference of PTA and INR before and after treatment in each group was statistically significant (P<0.05) , suggesting that both the two models had significant effects on improving the coagulation function; (4) Compared with the group of PE, the promotion of the PTA in PE+HDF group was better, and the difference was statistically significant (P<0.05) ;The PTA increased by 88±65% in group PE while increased by 102±73% in PE+HDF group; (5) By comparing the changes of blood ammonia before and after treatment between the two groups, blood ammonia had no improvement after treatment in group HE;And blood ammonia dropped significantly after treatment in PE+HDF group, with the statistically significant difference before and after ammonia treatment (P<0.05) .Blood ammonia decreased by 50.58±23.58% after treatment in group PE+HDF; (6) Renal function was damaged after treatment compared with that before treatment in PE group, which could cause the serum sodium to increase and serum potassium to decrease, with the statistically significant difference (P<0.05) ;In group PE+HDF, the treatment could improve the renal function and correct hyponatremia and hyperkalemia, with statistically significant difference (P<0.05) ; (7) Model for end-stage liver disease (MELD) score decreased after treatment both in HE group and PE+HDF group, and the differences of each group before and after treatment were statistically significant (P<0.05) ;Compared with the group of PE, PE+HDF group improved more in the end-stage liver disease score, and the difference was statistically significant (P <0.05) .Conclusion Compared with plasma exchange, plasma exchange combined with hemodiafiltration can increase the removal of albumin bound toxins (total bilirubin and bile acid) , is more effective in ptomoting prothrombin activity, and increasing the clearance of small and middle molecules so that the treatment is more effective on patients with liver failure complicated with hepatic encephalopathy, liver and kidney syndrome and internal environment disorder, etc;Both plasma exchange and plasma exchange combined with hemodiafiltration can significantly improve the model of end-stage liver disease, and reduce the risk of death and improve prognosis, but plasma exchange combined with hemodiafiltration is better.
- Artificial liver,
- Liver failure,
- Efficacy evaluation

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References(19)

References

[1] 中华医学会感染病分会肝衰竭与人工肝组, 中华医学会肝病学分会重型肝病与人工肝组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) 321-327.
[2]	[2]NEUBERGER J.Prediction of survival for patients with fulminant hepatic failure[J].Hepatology, 2005, 41 (1) :19-22.
[3]	[3]LI L J, ZHANG Y M, LIU X L, et al.Artificial liver support system in China:a review over the last 30 years[J].Ther Apher Dia, 2006, 10 (2) :160-167.
[4]	[4]ISONIEMI H, KOIVUSALO A M, REPO H, et al.The effect of albumin dialysis on cytokine levels in acute liver failure and need for liver transplantation[J].Transplant Proc, 2005, 37 (2) :1088-1090.
[5]段钟平.人工肝脏治疗学[M].北京:中国医药科技出版社, 2002:6.
[6]	[6]YUEN M F, SABLON E, HUI C K, et al.Prognostic factors in severe exacerbation of chronic heaptitis B[J].Clin Infect Dis, 2003, 36 (8) :979-984.
[7]	[7]ZHANG X Q, JIANG L, YOU J P, et al.Efficacy of short-term dexamethasone therapy in acuteon-chronic pre-liver failure[J].Hepatol Res, 2011, 41 (1) :46-53.
[8]罗红涛, 叶一农, 刘全妹, 等.MARS治疗与血浆置换联合血液透析治疗肝性脑病的观察[J].药品评价, 2007, 4 (1) :25-32.
[9]陈幼明, 朱建芸, 李建国, 等.血浆置换联合持续性血液滤过透析对慢性重型乙型病毒性肝炎临床症状及生化指标的影响[J].新医学, 2008, 39 (1) :13-16.
[10]叶卫江, 李兰娟, 俞海燕, 等.血浆置换联合血液滤过透析治疗慢性乙型重型肝炎的临床研究[J].中华肝脏病杂志, 2005, 13 (5) :370-373.
[11]	[11]NAKAE H, LGARASHI T, TAJIMI K, et al.Selective plasma exchange with dialysis in patients with acute liver failure[J].Ther Apher Dial, 2012, 16 (5) :467-471.
[12]	[12]SADAMOFI H, YA T, INKI M, et a1.Highflow rate hemodiafiltration as abrain support therapy proceeding to liver transplantation for hyperacute fulminant hepatic failure[J].Eur J Gastroenterol Hepatol, 2002, 14 (4) :435-439.
[13]	[13]NAKAE H, YONEKAWA, NARITA K, et al.Are proinflammatory cytokine concentrations reduced by plasma exchange in patents with severe acute hepatic failure[J].Res Commun mol Pathol Pharmacol, 2001, 109 (1-2) :65-72.
[14]	[14]RONCO C, TETTA C, MARIANO F, et al.Interpreting the mechanisms of continuous renal eplacement therapy in sepsis:the peak concentration hypothesis[J].Artif Organs, 2003, 27 (9) :792-801.
[15]	[15]SADAHIRO T, HIRASAWA H, ODA S, et al.Usefulness of plasma exchange plus continuous hemodia filtration to reduce adverse effects associated with plasma exchange in patients with acute liver failure[J].Crit Care Med, 2001, 29 (7) :1386-1392.
[16]	[16]KAMATH P S, WIESNER R H, MALINCHOC M, et al.Amodel to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.
[17]	[17]GITTO S, LORENZINI S, BISELLI M, et al.Allocation priority in non-urgent liver transplantation:An overview of proposed scoring systems[J].Digestive and Liver Disease, 2009, 41 (10) :700-706.
[18]	[18]RUF AE, KREMERS WK, CHAVEZ LL, et al.Addition of serum sodiuminto the MELD score predicts waiting list mortality better than MELD alone[J].Liver Transpl, 2005, 11 (3) :336-343.
[19]	[19]MAO W, YE B, LIN S, et a1.Prediction value of model for endstage liver disease scoring system on prognosis in the acute on chronic liver failure patients with plasma exchange treatment[J].ASAIO J, 2010, 56 (5) :475-478.

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