Effect Of Li’s Artificial Liver System In Hepatitis B Acute On Chronic Liver Failure

In the progress of chronic HBV infection, severe hepatitis (acute on chronic liver failure, ACLF), cirrhosis, hepatic carcinoma can occure and cause substantial social and economical burden. Hepatitis B liver failure is a critical condition with rapid progress and poor prognosis, currently there is still a lack of the effective medical treatment, mortality rate is as high as70%. Li’s artificial liver system, short for Li-ALS, achieved a major breakthrough in treatment of severe hepatits liver failure, and significantly reduced the mortality of patients. As early as2005, Academician Li Lanjuan and her team pointed out that combination of plasma exchange and continuous veno-venous hemofiltration is superior in treatment of mid-stage and late-stage chronic HBV-induced severe hepatits. This thesis is a case analysis of35hepatitis B ACLF patients treated with Li-ALS plasma exchange hemofiltration method.The study object is hepatitis B ACLF patients who was admitted in the first affiliated hospital, Zhejiang Univ. and treated with Li-ALS in the artificial liver center during2011.6.1and2012.1.30. By retrospective study, different index pre-and post Li-ALS treatment were analyzed, besides, a Cox proportional hazards regression model was established to analyze the impacting factors of prognosis.After the treatment of Li-ALS plasma exchange hemofiltration method, blood cells declined significantly, while biochemical index and coagulation fuction were vastly improved. Glutamic acid, methionine, cysteine, tyrosine, histidine decreased after Li-ALS treatment. The survival rate of1month and1year was51.4%and40.0%, respectively. When stratified according to different stage of liver failure, the survival rate of1month and1year was75.0%and50.0%for early stage,63.2%and47.4%for mid-stage,25.0%and25.0%for late stage. Four factors, MELD score (RR=1.379), white blood cell (RR=1.296), HBeAg (RR=0.083) and cholinesterase/1000(RR=0.552), were significant in the Cox proportional hazards regression model.Plasma Exchange could exclude middle and small molecular weight substance and more importatly large molecular weight toxins binding to plasma proteins, at the same time, coagulation factors and albumin were suplymented. While hemofiltration could maintain the balance of water, electrolytes and PH, and have better clear rate of middle molecular weight substances, which perfectly maked up the deficiencies of plasma exchange. So Li-ALS using plasma exchange hemofiltration method could remove blood toxins in a greater extent and thus further improve the survival rate of late stage patients compared to using Li-ALS plasma exchange method only.