目的:探讨甲胎蛋白(AFP)含量与慢加急性肝衰竭预后的关系,进一步了解肝衰竭患者AFP含量的变化。方法:将回顾分析的65 例慢加急性肝衰竭患者根据最后治疗结果分为存活组与死亡组,分析对比两组在不同时间AFP含量的差异,同时观察AFP含量与总胆红素(TBil),凝血酶原活动度(PTA)的关系。结果:65 例患者中AFP含量高于正常者53 例(81.54%),存活组不同时期的AFP含量平均值均高于死亡组,有显著差别(Plt;0.01)。AFP含量升高(≥300 IU/mL)主要分布在血清总胆红素lt;510 μmoL/ mL,凝血酶原活动度gt;30 %患者中,随AFP含量升高,病死率下降。结论:慢加急性肝衰竭患者血清AFP含量升高反应了肝细胞再生活跃,提示预后良好。
目的 总结肝移植治疗慢性重症肝炎急性肝衰竭的经验，以期改善预后。 方法 回顾性分析我院施行的3例慢性重症肝炎急性肝衰竭肝移植临床资料。结果 2例男性，1例女性，术前均诊断为慢性重症肝炎急性肝衰竭，肝功能Child分级均为C级，MELD评分分别为56.72、31.90及52.83，肝性脑病Ⅱ°～Ⅳ°，均合并肺部、腹腔感染，术前人工肝治疗1～3次，均行背驮式肝移植，术后病例3停用免疫抑制剂11 d，病例2和病例3痊愈出院，病例1因严重感染继发多器官功能衰竭死亡。结论 术前、术后人工肝支持改善内环境、术中及时补充凝血物质和术后有效控制感染是保证肝移植治疗慢性重症肝炎急性肝衰竭良好预后的关键措施。
【Abstract】Objective To evaluate effect of artificial liver support system (ALSS) in liver failure and liver transplantation.Methods Forty-four patients with liver failure (including 12 undergoing liver transplantation) were treated with MARS or plasma exchange. The changes of toxic substances and cytokines in blood were detected before and after treatment. Results ALSS therapy achieved a remarkable improvement in clinical symptoms and physical signs. After ALSS treatment, there was a significant decrease in total bilirubin, total bile acid, alanine aminotransferase, creatinine, urea nitrogen, blood ammonia and endotoxin levels(P＜0.05); the levels of serum NO, TNF-α, IL-4 and IL-6 were significantly decreased(P＜0.05); there was no statistical change in erythrocytes, leukocytes and platelets. The survival rate of 30 liver failure patients caused by severe hepatitis B was 60.0%(18/30). Six patients with acute liver failure were successfully performed liver transplantation. Two patients in 6 with acute liver failure after liver transplantation survived. One patient in 2 with acute liver failure after pancreatoduodenectomy survived. Conclusion ALSS plays a positive role in treatment of liver failure by removing blood toxins, NO and cytokines. ALSS also plays a substitute role for liver failure patients who are waiting for liver transplantation.
ObjectiveTo systematically review the efficacy and safety of plasma exchange (PE) versus routine medical therapy (RMT) for patients with chronic liver failure. MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 7, 2014), CBM, CNKI, and VIP from inception to August 2014, to collect randomized controlled trials (RCTs) and clinical controlled trials (CCTs) of PE versus RMT for chronic liver failure patients. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software. ResultsA total of 7 RCTs and 9 CCTs involving 1 632 patients (822 in the PE group and 810 in the RMT group) were included. The results of meta-analysis showed that:compared with the RMT group, the PE group had lower mortality rate (RCT:OR=0.24, 95%CI 0.13 to 0.43; CCT:OR=0.48, 95%CI 0.30 to 0.78) and higher total effective rate (RCT:OR=4.04, 95%CI 2.80 to 5.85; CCT:OR=3.45, 95%CI 2.11 to 5.64). Subgroup analysis based on the stage of liver failure showed that the PE group was superior to the RMT group in early- and intermediate-stage patients with liver failure in total effective rate (early stage:OR=4.78, 95%CI 1.87 to 12.23; intermediate stage:OR=4.43, 95%CI 1.77 to 11.08), but this difference was not found in advanced liver failure patients (OR=1.61, 95%CI 0.35 to 7.38). Seven studies reported 187 cases of adverse reactions (11.46%), and most of them were pruritus and urticaria. ConclusionCurrent evidence shows, compared with the routine medical therapy, the PE therapy could be effective to early- and intermediate-stage liver failure patients, but not be effective to advanced liver failure patients. In addition, patients who received the PE therapy have risks of adverse reactions which mainly are allergic reaction. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo summarize the changes and mechanism of related genes induced by stem cell therapy in acute-on-chronic liver failure (ACLF) in recent years, and in order to guide the clinical value of ACLF and curative effect evaluation. MethodsThrough searching Wanfang med, CNKI, Pubmed database and so on in recent years, the differentially expressed genes induced by stem cell therapy for ACLF in recent years was retrieved and the changes of related genes induced during the treatment process were discussed. ResultsBoth at home and abroad had reported that stem cell therapy in the process of ACLF caused mir-27b, TRAIL, and Tg737 genetic changes, some genetic changes had an fixed change trend. ConclusionsStem cells in the treatment of ACLF, cause mir-27b, TRAIL, Tg737 genetic changes, which can provides a new way and method for monitoring stem cell therapy ACLF.
The main treatment strategies for hepatic failure include drug therapy, artificial liver support system, and liver transplantation. This article introduces the clinically commonly used non biological artificial liver techniques, including plasma exchange, continuous blood purification, plasma bilirubin adsorption, plasma diafiltration, repeatedly pass albumin dialysis, molecular adsorbent recirculating system, Prometheus system, etc; and discusses how to select different artificial liver techniques according to different clinical manifestation. At the same time, the progress of bioartificial liver in recent years is summarized, and the future development of artificial liver is prospected.
ObjectiveTo systematically evaluate the risk factors for posthepatectomy liver failure (PHLF) of hepatobiliary malignancies in order to provide evidence-based medical basis for preventing and reducing PHLF.MethodsThe case-control studies on the risk factors of PHLF for hepatobiliary malignancy were searched in PubMed, CNKI, etc. domestic and foreign databases from January 2011 to March 2020. The quality evaluation of the literatures was performed by using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3.ResultsA total of 43 studies were included, involving 13 075 patients after hepatectomy, of which 1 943 (14.86%) had PHLF. Meta-analysis results showed that the male, liver cirrhosis, portal hypertension, hepatectomy range ≥3 segments, vascular tumor thrombus, intraoperative blood transfusion, tumor number ≥2, Child-Pugh grade ≥B, less platelet count, lower albumin, higher total bilirubin, higer indocyanine green retention rate at 15 minutes, longer hepatic hilar occlusion time, longer operation time, more intraoperative blood loss, bigger maximum tumor diameter, smaller residual liver volume, and higer MELD score were the risk factors for the occurrence of PHLF (P<0.05).ConclusionsAccording to the risk factors of PHLF, the basic condition, liver function, and residual liver volume should be fully evaluated before operation. The operation should be accurate anatomy, adequate hemostasis, timely treatment of intraoperative complications. After operation, the fluid infusion, anti-infection, correction of coagulation dysfunction, and protection of liver function should be strengthened. So incidence of PHLF might be reduced minimally.