中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 7
Jul.  2022
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(7): 1662-1666

Research advances in combined non-bioartificial liver in treatment of acute-on-chronic liver failure in adults

DOI: 10.3969/j.issn.1001-5256.2022.07.039

  • Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510635, China

Research funding:

The National Major Science and Technology Project for the Prevention and Treatment of AIDS and Viral Hepatitis (2018ZX10302204-002);

Natural Science Foundation of China (81873572);

Natural Science Foundation of China (82070611);

Sun Yat-Sen University Clinical Research 5010 Program (2020007);

The Five-Year Plan of Third Affiliated Hospital of Sun Yat-Sen University (K00006)

More Information
    Abstract
  • Acute-on-chronic liver failure (ACLF) is a common syndrome of severe liver diseases in clinical practice and has an extremely high short-term mortality rate. Non-bioartificial liver (NBAL) therapy is one of the effective treatment methods for patients with ACLF. In face of the current status of blood supply shortage and changes of treatment concepts, combined NBAL therapy can achieve mutual complementarity and better meet the clinical needs. This article focuses on the clinical application of NBAL in the treatment of ACLF and related research advances and summarizes existing problems and future prospects.

     

    • FullText(HTML)
  • loading
    • References(43)
  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [2]
    ARROYO V, MOREAU R, JALAN R. Acute-on-chronic liver failure[J]. N Engl J Med, 2020, 382(22): 2137-2145. DOI: 10.1056/NEJMrA1914900.
    [3]
    HERNAEZ R, KRAMER JR, LIU Y, et al. Prevalence and short-term mortality of acute-on-chronic liver failure: a national cohort study from the USA[J]. J Hepatol, 2019, 70(4): 639-647. DOI: 10.1016/j.jhep.2018.12.018.
    [4]
    Liver Failure and Artificial Liver Group, Branch of Infectious Diseases, Chinese Medical Association. Guideline for non-bioartificial liver support systems in treatment of liver failure: 2016 update[J]. Chin J Clin Infect Dis, 2016, 9(2): 97-103. DOI: 10.3760/cma.j.issn.1674-2397.2016.02.001.

    中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016年版)[J]. 中华临床感染病杂志, 2016, 9(2): 97-103. DOI: 10.3760/cma.j.issn.1674-2397.2016.02.001.
    [5]
    LI S, LIU J, CHEN Y. Non-bioartificial liver in liver failure: Clinical application and research advances[J]. J Clin Hepatol, 2019, 35(9): 1909-1915. DOI: 10.3969/j.issn.1001-5256.2019.09.004.

    李爽, 刘静, 陈煜. 非生物型人工肝在肝衰竭中的临床应用及进展[J]. 临床肝胆病杂志, 2019, 35(9): 1909-1915. DOI: 10.3969/j.issn.1001-5256.2019.09.004.
    [6]
    XU KL, LEI M, YUAN WF, et al. Effect of dual plasma molecular adsorption system in the treatment of hyperbilirubinemia in patients with liver failure[J]. Traum Crit Med, 2020, 8(2): 91-93, 96. DOI: 10.16048/j.issn.2095-5561.2020.02.08.

    许开亮, 雷鸣, 袁维方, 等. 双重血浆分子吸附系统治疗肝衰竭高胆红素患者疗效研究[J]. 创伤与急危重病医学, 2020, 8(2): 91-93, 96. DOI: 10.16048/j.issn.2095-5561.2020.02.08.
    [7]
    LI S, CHEN Y. Coping with shortage of plasma-The new therapeutic pattern of non-bioartificial liver[J]. J Clin Hepatol, 2017, 33(9): 1687-1692. DOI: 10.3969/j.issn.1001-5256.2017.09.012.

    李爽, 陈煜. 血浆紧缺情况下非生物型人工肝治疗新模式的探讨[J]. 临床肝胆病杂志, 2017, 33(9): 1687-1692. DOI: 10.3969/j.issn.1001-5256.2017.09.012.
    [8]
    KHATRI VP, PETRELLI NJ. Precision medicine[J]. Surg Oncol Clin N Am, 2020, 29(1): xv-xvi. DOI: 10.1016/j.soc.2019.10.001.
    [9]
    GUO LM. Clinical selection of individualizd artificial liver support[J]. Chin J Clin Infect Dis, 2017, 10(2): 113-118. DOI: 10.3760/cma.j.issn.1674-2397.2017.02.006.

    郭利民. 肝衰竭人工肝治疗的个体化选择[J]. 中华临床感染病杂志, 2017, 10(2): 113-118. DOI: 10.3760/cma.j.issn.1674-2397.2017.02.006.
    [10]
    ZHANG YM, XIE ZY, LI LJ. Progress and hotspots in diagnosis and treatment of liver failure[J]. Chin J Clin, 2020, 48(11): 1261-1265, 1258. DOI: 10.3969/j.issn.2095-8552.2020.11.001.

    章益民, 谢中阳, 李兰娟. 肝衰竭诊治进展与热点问题[J]. 中国临床医生杂志, 2020, 48(11): 1261-1265, 1258. DOI: 10.3969/j.issn.2095-8552.2020.11.001.
    [11]
    TAN EX, WANG MX, PANG J, et al. Plasma exchange in patients with acute and acute-on-chronic liver failure: a systematic review[J]. World J Gastroenterol, 2020, 26(2): 219-245. DOI: 10.3748/wjg.v26.i2.219.
    [12]
    WU C, ZHU Y, YU M. Serum metabonomics analysis of liver failure treated by nonbioartificial liver support systems[J]. Can J Gastroenterol Hepatol, 2018, 2018: 2586052. DOI: 10.1155/2018/2586052.
    [13]
    BLASI A, CID J, BELTRAN J, et al. Coagulation profile after plasma exchange using albumin as a replacement solution measured by thromboelastometry[J]. Vox Sang, 2016, 110(2): 159-165. DOI: 10.1111/vox.12347.
    [14]
    LI LJ. Liver failure and the progress of Li's artificial liver system[J]. Chin J Clin Infect Dis, 2017, 10(2): 91-94. DOI: 10.3760/cma.j.issn.1674-2397.2017.02.002.

    李兰娟. 肝衰竭与李氏人工肝进展[J]. 中华临床感染病杂志, 2017, 10(2): 91-94. DOI: 10.3760/cma.j.issn.1674-2397.2017.02.002.
    [15]
    LARSEN FS. Artificial liver support in acute and acute-on-chronic liver failure[J]. Curr Opin Crit Care, 2019, 25(2): 187-191. DOI: 10.1097/MCC.0000000000000584.
    [16]
    ZHOU J, WANG XX, LIAN JS, et al. Comparison of efficacy and safety between artificial liver plasma dia-filtration (PDF) and plasma exchange with continuous veno-venous hemofiltration (FPE+CVVH) for mid and late stage liver failure[J]. Chin J Clin Infect Dis, 2018, 11(5): 369-373. DOI: 10.3760/cma.j.issn.1674-2397.2018.05.008.

    周健, 王笑笑, 连江山, 等. 人工肝血浆透析滤过与选择性血浆置换联合连续性血液滤过治疗中晚期肝衰竭疗效及安全性比较[J]. 中华临床感染病杂志, 2018, 11(5): 369-373. DOI: 10.3760/cma.j.issn.1674-2397.2018.05.008.
    [17]
    YANG XS, ZHOU L, LI L, et al. Influence of duration of plasma diafiltration on therapeutic outcome of liver failure[J]. J Clin Hepatol, 2018, 34(5): 1052-1054. DOI: 10.3969/j.issn.1001-5256.2018.05.025.

    杨仙珊, 周莉, 李璐, 等. 血浆透析滤过治疗时间对肝衰竭治疗效果的影响[J]. 临床肝胆病杂志, 2018, 34(5): 1052-1054. DOI: 10.3969/j.issn.1001-5256.2018.05.025.
    [18]
    KOMURA T, TANIGUCHI T, SAKAI Y, et al. Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure[J]. J Gastroenterol Hepatol, 2014, 29(4): 782-786. DOI: 10.1111/jgh.12440.
    [19]
    GUO X, WU F, GUO W, et al. Comparison of plasma exchange, double plasma molecular adsorption system, and their combination in treating acute-on-chronic liver failure[J]. J Int Med Res, 2020, 48(6): 300060520932053. DOI: 10.1177/0300060520932053.
    [20]
    LIU CT, WU R, YU HY, et al. Double plasma molecular adsorption for patients with hepatitis B-associated acute-on-chronic liver failure[J]. Zhejiang Med J, 2019, 41(2): 125-131. DOI: 10.12056/j.issn.1006-2785.2019.41.2.2018-1086.

    刘春涛, 武瑞, 俞海燕, 等. 双重血浆分子吸附模式人工肝治疗乙肝相关慢加急性肝衰竭的疗效观察[J]. 浙江医学, 2019, 41(2): 125-131. DOI: 10.12056/j.issn.1006-2785.2019.41.2.2018-1086.
    [21]
    CHEN G, WU M, WU B, et al. Effects of dual plasma molecular adsorption system on liver function, electrolytes, inflammation, and immunity in patients with chronic severe hepatitis[J]. J Clin Lab Anal, 2019, 33(7): e22926. DOI: 10.1002/jcla.22926.
    [22]
    ZHONG S, WANG N, ZHAO J, et al. Plasma exchange combined with double plasma absorption therapy improve the prognosis of acute-on-chronic liver failure[J]. Chin J Hepatol, 2018, 26(10): 744-749. DOI: 10.3760/cma.j.issn.1007-3418.2018.10.003.

    钟珊, 王娜, 赵静, 等. 血浆置换联合双重血浆吸附治疗提高慢加急性肝衰竭预后[J]. 中华肝脏病杂志, 2018, 26(10): 744-749. DOI: 10.3760/cma.j.issn.1007-3418.2018.10.003.
    [23]
    YAO J, LI S, ZHOU L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure[J]. J Clin Apher, 2019, 34(4): 392-398. DOI: 10.1002/jca.21690.
    [24]
    YANG Q, GENG Q, SUN CF, et al. Efficacy of plasma exchange combined with dual plasma molecular adsorption system in the treatment of patients with hepatitis B virus related acute-on-chronic liver failure[J]. Chin J Clin Infect Dis, 2021, 39(7): 430-435. DOI: 10.3760/cma.j.cn311365-20201021-00820.

    杨晴, 耿强, 孙长峰, 等. 血浆置换联合双重血浆分子吸附系统治疗乙型肝炎病毒相关慢加急性肝衰竭患者疗效的分析[J]. 中华传染病杂志, 2021, 39(7): 430-435. DOI: 10.3760/cma.j.cn311365-20201021-00820.
    [25]
    YE YN, GAO ZL. Three shock hypotheses that my induce liver failure[J]. Infect Dis Info, 2009, 22(5): 276-279. DOI: 10.3969/j.issn.1007-8134.2009.05.006.

    叶一农, 高志良. 乙型肝炎肝衰竭发生机制中的三重打击[J]. 传染病信息, 2009, 22(5): 276-279. DOI: 10.3969/j.issn.1007-8134.2009.05.006.
    [26]
    ZHU QR, WANG CL, LIU J, et al. Changes of serum cytokines in patients with hepatic failure after molecular adsorption recycling system therapy[J]. J Pract Hepatol, 2017, 20 (1): 107-108. DOI: 10.3969/j.issn.1672-5069.2017.01.029.

    朱其荣, 王川林, 刘娇, 等. 分子吸附再循环系统对肝衰竭患者血清Th1/Th2型细胞因子水平的影响[J]. 实用肝脏病杂志, 2017, 20(1): 107-108. DOI: 10.3969/j.issn.1672-5069.2017.01.029.
    [27]
    CHANG L, ZHOU P, FENG XL. Influence of double plasma molecular adsorption system for the inflammatory cytokines and chemokines of patients with acute liver failure[J]. Traum Crit Med, 2018, 6(4): 211-213, 216. DOI: 10.16048/j.issn.2095-5561.2018.04.07.

    常莉, 周平, 冯璇璘. 双重血浆分子吸附系统对急性肝功能衰竭患者炎性细胞因子及趋化因子影响研究[J]. 创伤与急危重病医学, 2018, 6(4): 211-213, 216. DOI: 10.16048/j.issn.2095-5561.2018.04.07.
    [28]
    ZHU LN, HUANG CJ, ZHAO QY, at al. Effect of combined artificial liver on serum Th1/Th2 cytokines in patients with liver failure[J]. Chin J Clin Gastroenterol, 2020, 32(1): 41-45. DOI: 10.3870/lcxh.j.issn.1005-541X.2020.01.010.

    朱立娜, 黄初军, 赵秋燕, 等. 组合型人工肝对肝功能衰竭患者血清Th1/Th2型细胞因子的影响[J]. 临床消化病杂志, 2020, 32(1): 41-45. DOI: 10.3870/lcxh.j.issn.1005-541X.2020.01.010.
    [29]
    ZHAO JT, WANG L, YU HL. Effects of double plasma molecular adsorption system combined with plasma exchange on cytokines expression and liver function in patients with liver failure[J]. Mod Med J, 2020, 48(10): 1264-1267. DOI: 10.3969/j.issn.1671-7562.2020.10.004.

    赵婧婷, 王莉, 余洪烈. 双重血浆吸附联合血浆置换对肝衰竭患者细胞因子表达及肝功能的影响[J]. 现代医学, 2020, 48(10): 1264-1267. DOI: 10.3969/j.issn.1671-7562.2020.10.004.
    [30]
    BAARES R, NEVENS F, LARSEN FS, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial[J]. Hepatology, 2013, 57(3): 1153-1162. DOI: 10.1002/hep.26185.
    [31]
    GERTH HU, POHLEN M, THLKING G, et al. Molecular adsorbent recirculating system can reduce short-term mortality among patients with acute-on-chronic liver failure-a retrospective analysis[J]. Crit Care Med, 2017, 45(10): 1616-1624. DOI: 10.1097/CCM.0000000000002562.
    [32]
    OCSKAY K, KANJO A, GEDE N, et al. Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis[J]. Ann Intensive Care, 2021, 18, 11(1): 10. DOI: 10.1186/s13613-020-00795-0.
    [33]
    TANDON R, FROGHI S. Artificial liver support systems[J]. J Gastroenterol Hepatol, 2021, 36(5): 1164-1179. DOI: 10.1111/jgh.15255.Epub2020Oct3.
    [34]
    KRISPER P, STADLBAUER V, STAUBER RE. Clearing of toxic substances: are there differences between the available liver support devices?[J]. Liver Int, 2011, 31(Suppl 3): 5-8. DOI: 10.1111/j.1478-3231.2011.02588.x.
    [35]
    BJERRING PN, HAUERBERG J, FREDERIKSEN HJ, et al. The effect of fractionated plasma separation and adsorption on cerebral amino acid metabolism and oxidative metabolism during acute liver failure[J]. J Hepatol, 2012, 57(4): 774-779. DOI: 10.1016/j.jhep.2012.06.004.
    [36]
    HE YT, QI YN, ZHANG BQ, et al. Bioartificial liver support systems for acute liver failure: A systematic review and meta-analysis of the clinical and preclinical literature[J]. World J Gastroenterol, 2019, 25(27): 3634-3648. DOI: 10.3748/wjg.v25.i27.3634.
    [37]
    LEE KC, STADLBAUER V, JALAN R. Extracorporeal liver support devices for listed patients[J]. Liver Transpl, 2016, 22(6): 839-848. DOI: 10.1002/lt.24396.
    [38]
    LI JJ, SUN YY, JIANG WT. Application and progress of artificial liver support system in liver transplantation[J]. Int J Trans and Hemopur, 2021, 19(3): 1-4. DOI: 10.3760/cma.j.cn115399-20210421-03001.

    李俊杰, 孙岩岩, 蒋文涛. 人工肝支持系统在肝移植中的应用现状及进展[J]. 国际移植与血液净化杂志, 2021, 19(3): 1-4. DOI: 10.3760/cma.j.cn115399-20210421-03001.
    [39]
    KUANG YL, YUAN WJ, ZHANG Z, et al. The short-term prognosis and the mechanism of non-bioartificial liver support system to the peri-operative liver transplantation of liver failure patient[J]. Chin J Blood Purificat, 2011, 10(2): 91-96. DOI: 10.3969/j.issn.1671-4091.2011.02.010.

    邝永玲, 袁伟杰, 张政, 等. 人工肝支持系统对肝移植围手术期的肝衰竭患者短期预后影响及机制探讨[J]. 中国血液净化, 2011, 10(2): 91-96. DOI: 10.3969/j.issn.1671-4091.2011.02.010.
    [40]
    WANG YH, ZHU X, FENG DY, et al. Artificial liver support system for acute-on-chronic liver failure combined with successful liver transplantation in stage Ⅲ-Ⅳ hepatic encephalopathy: an analysis of 14 cases[J]. Chin J Hepatol, 2018, 26(9): 676-679. DOI: 10.3760/cma.j.issn.1007-3418.2018.09.008.

    王艳红, 朱翔, 冯定云, 等. 人工肝支持慢加急性肝衰竭合并Ⅲ~Ⅳ期肝性脑病患者成功完成肝移植14例分析[J]. 中华肝脏病杂志, 2018, 26(9): 676-679. DOI: 10.3760/cma.j.issn.1007-3418.2018.09.008.
    [41]
    WANG N, CAI WL, LI HX, et al. Application of DPMAS combined with low dose plasma exchange in perioperative hepatic failure after liver transplantation[J]. Chin Med Eng, 2019, 27(12): 54-57. DOI: 10.19338/j.issn.1672-2019.2019.12.015.

    王柠, 蔡文利, 李海霞, 等. 双重血浆分子吸附系统联合小剂量血浆置换在肝移植围手术期肝衰竭治疗中的应用[J]. 中国医学工程, 2019, 27(12): 54-57. DOI: 10.19338/j.issn.1672-2019.2019.12.015.
    [42]
    DU L, MA Y, ZHOU S, et al. A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system[J]. Sci Rep, 2021, 11(1): 1469. DOI: 10.1038/s41598-021-81019-8.
    [43]
    SHANG J, WANG M, WEN Q, et al. A novel prognostic model to predict outcome of artificial liver support system treatment[J]. Sci Rep, 2021, 11(1): 7510. DOI: 10.1038/s41598-021-87055-8.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索
    Get Citation
    PDF
    XML

    Article Metrics

    Article views (571) PDF downloads(54) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return