不同病因的急性肝衰竭患者经人工肝治疗的预后

发布时间：2018-02-09 15:52

本文关键词： 急性肝衰竭药物性肝损伤人工肝支持　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:急性肝衰竭是一种较为复杂的多系统性疾病,其表现为肝功能逐渐减退和导致发展成为从昏迷进一步恶化至神志不清的肝性脑病。急性肝衰竭死亡率高,需要得到即时快速有效的治疗。目前,肝移植已经成为最有效的治疗方法。由于肝脏数量有限及和捐献资源有限,因此进行了多项研究,旨在开发出一种新的治疗技术。人工肝具有多种功能,如解毒、凝血功能障碍矫正、抑制炎症、促进肝细胞再生,这种方法可以作为延长急性肝衰竭患者生存时间的替代方法。本研究旨在发现人工肝系统在实验室参数下对不同病因的急性肝衰竭患者的有效性,并确定急性肝衰竭患者的预后因子。方法:2011年1月1日至2016年12月31日收治的急性肝衰竭患者共计197例测定后纳入本研究。已从所有患者或其亲属处获得书面同意。该方法经当地伦理委员会批准,符合《赫尔辛基宣言》。本研究的排除标准如下:患者在入院前接受人工肝支持治疗、接受移植、慢加急性肝衰竭、不可控制的全身或颅内出血、怀孕、用血管紧张素转换酶抑制剂治疗和严重低血压。以下实验室参数得到记录,包括:年龄、性别、急性肝衰竭的病因、生存或死亡、血液检查、肝脏血清、INR、APTT、PT和钠血清。分析所有患者的血清样本,确定急性肝衰竭的病因。肝性脑病基于临床表现。首先分析了接受人工肝治疗的急性肝衰竭患者作为实验组,不接受人工肝治疗的急性肝衰竭患者作为对照组。将对人工肝支持在不同病因的急性肝衰竭患者中的有效性作出分析。结果:人工肝治疗能显著改善肝功能。在Dili组里,与实验组相比,血肌酐显著降低,尽管在接受人工肝治疗后,两组的肝功能得到了显著改善。人工肝支持疗程数与二十八天生存率高度相关结论:人工肝支持治疗对急性肝衰竭患者而言是安全有效的。据报道,人工肝支持治疗后实验室参数改善,使得生存率升高。因此,到目前为止,人工肝支持仍被认为是肝移植的"桥接工具"。此外,还需要进一步的研究来预测开始人工肝支持治疗的准确时间。多项研究表明,人工肝支持对终末期肝病患者具有积极价值,因此需要对人工肝支持的功能做出优化。
[Abstract]:Background: acute liver failure is a complex multisystemic disease characterized by a gradual decline in liver function and the development of hepatic encephalopathy from coma to confusion. Acute liver failure has a high mortality rate. There is a need for immediate, rapid and effective treatment. Liver transplantation is now the most effective treatment. Because of the limited number of livers and limited donor resources, a number of studies have been carried out. In order to develop a new therapeutic technique, artificial liver has many functions, such as detoxification, correction of coagulation dysfunction, inhibition of inflammation and promotion of hepatocyte regeneration. This method can be used as an alternative to prolong the survival time of patients with acute liver failure. The purpose of this study was to find out the effectiveness of artificial liver system in patients with acute liver failure with different etiology under laboratory parameters. Methods: a total of 197 patients with acute liver failure admitted from January 1st 2011 to December 31st 2016 were included in this study. Written identity was obtained from all patients or their relatives. The method is approved by the local ethics committee, In accordance with the Helsinki Declaration, the criteria for exclusion in this study were as follows: patients received artificial liver support treatment prior to admission, received transplantation, slow and acute liver failure, uncontrolled systemic or intracranial hemorrhage, pregnancy, Treatment with angiotensin converting enzyme inhibitors and severe hypotension. The following laboratory parameters were recorded, including age, sex, etiology of acute liver failure, survival or death, blood tests, The serum samples of all patients were analyzed to determine the etiology of acute hepatic failure. Hepatic encephalopathy was based on clinical manifestations. First, the patients with acute liver failure treated with artificial liver were analyzed as experimental group. The effectiveness of artificial liver support in patients with acute liver failure with different etiology was analyzed. Results: artificial liver therapy significantly improved liver function. Compared with the experimental group, serum creatinine decreased significantly, although after treatment with artificial liver, Liver function was significantly improved in both groups. The number of courses of artificial liver support was highly correlated with the 28 day survival rate. Conclusion: artificial liver support therapy is safe and effective in patients with acute liver failure. Laboratory parameters are improved after artificial liver support therapy, which increases survival rate. So far, artificial liver support is still considered as a "bridging tool" for liver transplantation. Further studies are needed to predict the exact time to begin artificial liver support therapy. Several studies have shown that artificial liver support is of positive value in patients with end-stage liver disease and therefore needs to optimize the function of artificial liver support.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.3

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