针对急性肝衰竭的分子吸附剂循环系统在一个新的基于儿科的体外肝支持计划中.
David R Baker1, Helen Mac2, Benjamin Steinman3
1Division of Pediatric Critical Care, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
Critical care explorations
|November 13, 2023
概括
针对急性肝衰竭 (ALF) 的分子吸附剂循环系统 (MARS) 治疗显著改善了患者的治疗结果,并减少了肝脏脑病变. 这种体外肝脏支持显示出改善ALF患者生存率的希望.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 身体外的肝脏支持
- 关键护理医学 关键护理医学
背景情况:
- 急性肝衰竭 (ALF) 具有显著的死亡风险,肝脑病变 (HE) 是主要的驱动因素.
- 使用分子吸附剂循环系统 (MARS) 进行白蛋白透析是一种体外肝支持 (ELS) 方式,旨在减轻ALF中的HE.
- 现有的关于MARS对ALF死亡率的影响数据仍然不一致,需要进一步调查.
研究的目的:
- 评估MARS治疗在患有ALF的儿童和成人患者的结果.
- 评估使用MARS在儿科肝移植中心内新成立的ELS计划的有效性.
主要方法:
- 在2021年至2022年期间,对ALF用MARS治疗的患者 (儿科和成人) 的回顾性评估.
- 结果分析包括HE的减少,ALF生化标志物的改善,整体存活率和无移植存活率.
- 统计分析使用威尔科克森签名等级测试进行结果比较.
主要成果:
- 七名患者 (5名儿科,2名成年人) 接受了ALF的MARS治疗,每名患者的中位数为3次.
- 在HE得分 (p=0.03) 和关键ALF生物标志物如氨 (p=0.02),AST (p=0.02),ALT (p=0.02) 和INR (p=0.02) 中观察到显著降低.
- 总生存率为85.7%,无移植生存率为71.4%.
结论:
- 在儿童和成人ALF患者中,MARS疗法耐受性良好,导致显著的临床和生化改善.
- 鼓舞人心的整体和无移植生存率表明,早期MARS启动具有足够的持续时间和频率的潜在好处.
- 需要在更大的队列中进行进一步的研究,以确认MARS在ALF管理中的有效性.
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