A Primary Evaluation On Severe Hepatitis Treated With Non-bioartificial Liver Support System

For half a century, a great number of studies in China and foreign countries focused on acute liver failuer treatment with artificial liver support system. And the clinical effect had been confirmed. The non-bioartificial liver support system(NBALSS) has been used widely in clinical departments. The clinical effects of NBALSS are very different according to the reports of different study groups. To evaluate the clinical effect of NBALSS objectively and widely, we investigated the in vitro and in vivo abilities of HA-adsorbing resin to remove toxin from human plasma and asssessed the outcome of severe hepatitis treated with typical BALSS.In in vitro study, the plasma of severe hepatitis patients was collected and recirculated through the resin column. The removal of bilirubin, endotoxin and cytokines was evaluated at 80-120ml/min flow rates. In in vivo study, 7 patients with severe hepatitis were treated with plasma perfusion(PP) and 10 patients were treated with plasma exchange(PE). Regular blood tests including liver and renal function,blood ammonia,endotoxin,cytokines were performed, and the patients were closely observed.The in vitro study showed significant decreases in levels of plasma total bilirubin, tumor necrosis factor-alpha and endotoxin(ET). Blood creatinine and uria nitrogen decreased slightly. No changes were observed in blood anmonia, electrolure and interleukin-6.In in vivo study, the symptoms of patients treated with PP were improved to different extent. But no obvious decrease was observed in death rate. Aftertreating with PP, some cytokins and ET decreased greatly, while bilirubin decreased slightly. The changes of electrolure and interleukin-6 were very limited.The outcome of patients treated with PE was very similar with those treated with PP. But compared with the latter, the removal of bilirubin of former was higher and that of cytokines was lower.Conclusions: 1. Adsorbing resin can adsorb bilirubin and cytokines in the blood of severe hapatitis patients. The applying prospect is very optimistic.2.As a therapeutic tool for severe hapatitis, PP is safe and reliable, which can remove cytokines with high efficiency and retard the natual procedure of hepatic failure.3.PE can decrease the biochemical indexs of patients, especially for bilirubin. And PE can provide coagulation factors, which makes it be a relative safe and effective therapeutic tool for severe hapatitis.4. NBALSS can improve the clinical symptoms of patients temporariely, but has no effect on death rate. The future development of NBALSS is to be used together with BALSS, which can improve the patients' outcome and decrease the death rate.