非生物型人工肝支持系统治疗慢加急性肝衰竭的应用
Application of Non-Biological Artificial Liver Support System in the Treatment of Acute-on-Chronic Liver Failure
DOI: 10.12677/acm.2025.1541261, PDF,   
作者: 姜万祥:赣南医科大学第一附属医院,江西 赣州;孟 凡:赣南医科大学第一附属医院消化内科,江西 赣州
关键词: 人工肝慢加急性肝衰竭血液透析双重血浆分子吸附系统Artificial Liver Acute-on-Chronic Liver Failure Hemodialysis Double Plasma Molecular Adsorption System
摘要: 慢加急性肝衰竭是临床常见的综合征,其短期死亡率较高,通过非生物型人工肝代替肝脏解毒,并利用肝脏再生潜力,达到肝脏功能的恢复或临床改善,对于重症患者,可有效维持患者生命体征。针对目前血液资源、肝脏配型资源稀缺的现状,越来越多的研究重视了各类人工肝的组合治疗模式。本文将对目前较为广泛使用的非生物型人工肝的应用研究做出部分总结。
Abstract: Acute-on-chronic liver failure is a common clinical syndrome with a relatively high short-term mortality rate. The non-biological artificial liver can replace the liver in detoxification and utilize the liver’s regenerative potential to achieve the restoration or clinical improvement of liver function. For critically ill patients, it can effectively maintain the patients’ vital signs. In view of the current situation of the scarcity of blood resources and liver matching resources, more and more studies have attached importance to the combined treatment models of various artificial livers. This article will make some summaries of the current application research on the non-biological artificial liver that is widely used.
文章引用:姜万祥, 孟凡. 非生物型人工肝支持系统治疗慢加急性肝衰竭的应用[J]. 临床医学进展, 2025, 15(4): 2953-2958. https://doi.org/10.12677/acm.2025.1541261

参考文献

[1] 项晓刚, 尚大宝, 张金铭. 慢加急性肝衰竭的疾病定义及发病机制[J]. 临床肝胆病杂志, 2023, 39(10): 2281-2287.
[2] Moreau, R., Gao, B., Papp, M., Bañares, R. and Kamath, P.S. (2021) Acute-on-Chronic Liver Failure: A Distinct Clinical Syndrome. Journal of Hepatology, 75, S27-S35. [Google Scholar] [CrossRef] [PubMed]
[3] Zaccherini, G., Weiss, E. and Moreau, R. (2021) Acute-on-Chronic Liver Failure: Definitions, Pathophysiology and Principles of Treatment. JHEP Reports, 3, Article 100176. [Google Scholar] [CrossRef] [PubMed]
[4] Wlodzimirow, K.A., Eslami, S., Abu‐Hanna, A., Nieuwoudt, M. and Chamuleau, R.A.F.M. (2012) A Systematic Review on Prognostic Indicators of Acute on Chronic Liver Failure and Their Predictive Value for Mortality. Liver International, 33, 40-52. [Google Scholar] [CrossRef] [PubMed]
[5] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018 年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44.
[6] Moreau, R., Jalan, R., Gines, P., Pavesi, M., Angeli, P., Cordoba, J., et al. (2013) Acute-on-Chronic Liver Failure Is a Distinct Syndrome That Develops in Patients with Acute Decompensation of Cirrhosis. Gastroenterology, 144, 1426-1437.e9. [Google Scholar] [CrossRef] [PubMed]
[7] Bajaj, J.S., O’Leary, J.G., Lai, J.C., Wong, F., Long, M.D., Wong, R.J., et al. (2022) Acute-on-Chronic Liver Failure Clinical Guidelines. American Journal of Gastroenterology, 117, 225-252. [Google Scholar] [CrossRef] [PubMed]
[8] Fernández, J., Acevedo, J., Wiest, R., Gustot, T., Amoros, A., Deulofeu, C., et al. (2017) Bacterial and Fungal Infections in Acute-on-Chronic Liver Failure: Prevalence, Characteristics and Impact on Prognosis. Gut, 67, 1870-1880. [Google Scholar] [CrossRef] [PubMed]
[9] Trebicka, J., Bork, P., Krag, A. and Arumugam, M. (2020) Utilizing the Gut Microbiome in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure. Nature Reviews Gastroenterology & Hepatology, 18, 167-180. [Google Scholar] [CrossRef] [PubMed]
[10] Bajaj, J.S., O'Leary, J.G., Reddy, R.K., Wong, F., Biggins, S.W., Patton, H., et al. (2014) Survival in Infection-Related Acute-On-Chronic Liver Failure Is Defined by Extrahepatic Organ Failures. Hepatology, 60, 250-256. [Google Scholar] [CrossRef] [PubMed]
[11] Philips, C.A., Augustine, P., Yerol, P.K., et al. (2019) Severe Alcoholic Hepatitis: Current Perspectives. Hepatic Medicine: Evidence and Research, 11, 97-108.
[12] Hernaez, R., Solà, E., Moreau, R. and Ginès, P. (2017) Acute-on-Chronic Liver Failure: An Update. Gut, 66, 541-553. [Google Scholar] [CrossRef] [PubMed]
[13] Huang, K., Ji, F., Xie, Z., Wu, D., Xu, X., Gao, H., et al. (2019) Artificial Liver Support System Therapy in Acute-On-Chronic Hepatitis B Liver Failure: Classification and Regression Tree Analysis. Scientific Reports, 9, Article No. 16462. [Google Scholar] [CrossRef] [PubMed]
[14] 中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016年版)[J]. 中华临床感染病杂志, 2016, 9(2): 97-103.
[15] 杨晓莉, 李剀. 血浆置换联合替诺福韦酯治疗HBV感染相关慢加急性肝衰竭的疗效[J]. 中华医院感染学杂志, 2021, 31(17): 2604-2608.
[16] 张行芬, 邓勤智. 5%白蛋白用于人工肝选择性血浆置换治疗的有效性和安全性评价[J]. 中国现代医生, 2016, 54(13): 27-30.
[17] Wang, L., Xu, W.X. and Peng, L. (2022) Research Advances in Combined Non-Bioartificial Liver in Treatment of Acute-on-Chronic Liver Failure in Adults. Journal of Clinical Hepatology, 38, 1662-1666.
[18] 周健, 王笑笑. 人工肝血浆透析滤过与选择性血浆置换联合连续性血液滤过治疗中晚期肝衰竭疗效及安全性比较[J]. 中华临床感染病杂志, 2018, 11(5): 369-373.
[19] Tandon, R. and Froghi, S. (2020) Artificial Liver Support Systems. Journal of Gastroenterology and Hepatology, 36, 1164-1179. [Google Scholar] [CrossRef] [PubMed]
[20] 秦华, 魏丽. 双重血浆分子吸附联合血浆置换治疗慢加急性肝衰竭的疗效分析[J]. 临床荟萃, 2019, 34(7): 633-636.
[21] Wu, M., Zhang, H., Huang, Y., Wu, W., Huang, J. and Yan, D. (2021) Efficiency of Double Plasma Molecular Absorption System on the Acute Severe Cholestatic Hepatitis. Blood Purification, 50, 876-882. [Google Scholar] [CrossRef] [PubMed]
[22] Yao, J., Li, S., Zhou, L., Luo, L., Yuan, L., Duan, Z., et al. (2019) Therapeutic Effect of Double Plasma Molecular Adsorption System and Sequential Half-Dose Plasma Exchange in Patients with HBV-Related Acute-on-Chronic Liver Failure. Journal of Clinical Apheresis, 34, 392-398. [Google Scholar] [CrossRef] [PubMed]
[23] 陈黎, 杨林. 部分血浆置换联合双重血浆分子吸附对慢加急性肝衰竭患者短期生存率的影响[J]. 实用医学杂志, 2020, 36(23): 32-37.
[24] 钟珊, 王娜. 血浆置换联合双重血浆吸附治疗提高慢加急性肝衰竭预后[J]. 中华肝脏病杂志, 2018, 26(10): 744-749.
[25] Lee, K.C.L., Stadlbauer, V. and Jalan, R. (2016) Extracorporeal Liver Support Devices for Listed Patients. Liver Transplantation, 22, 839-848. [Google Scholar] [CrossRef] [PubMed]
[26] Komardina, E., Yaroustovsky, M., Abramyan, M. and Plyushch, M. (2017) Prometheus Therapy for the Treatment of Acute Liver Failure in Patients after Cardiac Surgery. Polish Journal of Cardio-Thoracic Surgery, 4, 230-235. [Google Scholar] [CrossRef] [PubMed]
[27] Rifai, K., Bode-Boeger, S.M., Martens-Lobenhoffer, J., Ernst, T., Kretschmer, U., Hafer, C., et al. (2010) Removal of Asymmetric Dimethylarginine during Artificial Liver Support Using Fractionated Plasma Separation and Adsorption. Scandinavian Journal of Gastroenterology, 45, 1110-1115. [Google Scholar] [CrossRef] [PubMed]
[28] Şentürk, E., Esen, F., Özcan, P.E., Rifai, K., Pinarbaşi, B., Çakar, N., et al. (2010) The Treatment of Acute Liver Failure with Fractionated Plasma Separation and Adsorption System: Experience in 85 Applications. Journal of Clinical Apheresis, 25, 195-201. [Google Scholar] [CrossRef] [PubMed]
[29] Dethloff, T., Tofteng, F., Frederiksen, H., Hojskov, M., Hansen, B.A. and Larsen, F.S. (2008) Effect of Prometheus Liver Assist System on Systemic Hemodynamics in Patients with Cirrhosis: A Randomized Controlled Study. World Journal of Gastroenterology, 14, 2065-2071. [Google Scholar] [CrossRef] [PubMed]