| BackgroundLiver failure, caused by a variety of pathogens,is a state of severe hepatic decompensation.It is aways accompanied by severe metabolic disorders and accumulation of toxic metabolites in the body.These toxic substances could promote liver cells damage and inhibit liver cells regeneration, creating a vicious cycle.In China, hepatitis B virus infection is a major cause of liver failure. The clinical medical therapy is not so ideal that the mortality is still as high as60%. Liver transplantation is still recognized as the only measure to improve the survival rate of patients with liver failure now.However,it is difficult to spread in clinic mainly because of the scarcity of donor organs and high cost.Artifical liver support system (ALSS,referred as artificial liver) has become an important adjunct measure in patients with liver failure.This system could improve liver environment in time by its fast and reliable detoxifying function which could create suitable conditions for liver cells regeneration.It is hopeful that the disease could be finally recovery.Artificial liver has been used in clinical for more than a decade. However,there are still many controversials to its clinical value. In this clinical study,308cases with hepatitis B related liver failure in Department of Infectious Disease of Wuhan Tongji Hospital were analyzed in prospective clinical study,by which to analyse the influence of non-bioartificial liver on efficacy and prognosis of chronic hepatitis B related liver failure.Objective1To investigate non-bioartificial liver’s clinical efficacy of patients with chronic hepatitis B related liver failure;2To investigate non-bioartificial liver’s influence on prognosis of patients with chronic hepatitis B related liver failure;3To explore intervention timing of non-bioartificial liver for patients with chronic hepatitis B related liver failure.Methods308cases of liver failure patients who hospitalized in Tongji Hospital (Wuhan) were analyzed in perspective clinical study. Patients who accepted non-bioartificial liver support system on the basis of standard medical treatment were defined as ALSS group.The ones who accepted standard medical treatment only were defined as SMT group or control group.Both of the two groups were divided into three groups of early,medium and advanced stage respectively.Taking8-week as an observation point,we recorded patients’ symptoms,signs and biochemical parameters,such as liver function and clotting function. According to them,we could determine the clinical efficacy of patients.Taking the time when patients admitted to hospital and accepted treatment as a starting point,and we took48-week as ending point and recorded the survival time of cases.We took advantage of SPSS17.0statistical software to make survival curve and by which to determine the prognosis of our patients with liver failure.The difference of survival rate between two groups was compared by Log Rank test. ResultsNon-bioartificial liver could improve clinical symptoms and signs, liver function and coagulation function of patients with liver failure(comparing with pre-artificial liver,the level of ALT,TBil were reduced by63.6U/L and34.17umol/L respectively, PTA was increased by7.71%,P<0.01). At8-week,the difference of clinical efficiency of ALSS group was better than SMT group (52.07%vs34.07%, P=0.004).12-week cumulative survival rate of ALSS group and SMT group were50.4%and42.1%respectively, and the difference between them was not statistical significant (P>0.05). After following up48weeks,the average survival time of patients in ALSS group was186.2±11.5days while it was160.3±19.0days in SMT group patients.The difference of48-week cumulative survival rate between two groups was not statistical significant (44.3%vs40.7%, P=0.057).Besides,for patients with liver failure in early stage,12-week cumulative survival rate of ALSS group and SMT group were81.8%and79.4%respectively.The difference between them was not statistical significant (P>0.05).After following up48weeks,the average survival time of ALSS group was284.0±18.1days while it was279.1±33.1days in SMT group patients.The difference of48-week cumulative survival rate between two groups was not statistical significant (72.7%vs73.3%,P=0.897).The result was nearly the same to patients with advanced liver failure.12-week cumulative survival rate of ALSS group and SMT group were14.9%and15.3%respectively.The difference between them was not statistical significant (P>0.05).The average survival time of ALSS group and SMT group was68.2±113.2days and57.6±20.3days respectively,and the difference of48-week cumulative survival rate was of no statistical significance (9.6%vs12.3%, P=0.062).However,when it came to cases with medium liver failure that12-week cumulative survival rate of ALSS group and SMT group were62.3%and42.9%respectively.The difference between them was statistical significant (P<0.05). After following up48weeks,the average survival time of ALSS group was229.9±18.3days while it was168.3±34.7days in SMT group patients.The difference of48-week cumulative survival rate between two groups was statistical significant(56.7%vs42.9%, P=0.040).ConclusionNon-bioartificial liver could improve clinical symptoms and signs, liver function and coagulation function of patients with liver failure.Besides,it could increase12-week and48-week cumulative survival rate of patients with liver failure in medium term, so it should be involved in their therapy actively.To patients in early stage or advanced liver failure,the value of non-bioartificial liver was little. So we could give them standard medical therapy mainly rather than giving artificial liver intervention positive overly,except for patients with advanced liver failure who wait for liver transplantation. |
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