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1.
Journal of Clinical Hepatology ; (12): 135-140, 2022.
Article in Chinese | WPRIM | ID: wpr-913127

ABSTRACT

Objective To systematically review the efficacy of different artificial liver support systems in the treatment of acute-on-chronic liver failure (ACLF) using a network Meta-analysis. Methods PubMed, Embase, the Cochrane library, Clinical Trial, CNKI, SinoMed, and Wanfang Data were searched for randomized controlled trials (RCTs) on different artificial liver support systems in the treatment of ACLF. Literature screening, data extraction, and method ological quality assessment were performed according to inclusion and exclusion criteria, and Stata15.1 software and R4.1.0 software were used to perform a network Meta-analysis. Results A total of 14 RCTs were included, with 1141 patients in total. The network meta-analysis showed different intervention methods had no significant difference in reducing mortality rate based on cross comparison (all P > 0.05). The probability ranking diagram showed that plasma exchange (PE) showed the best effect in reducing 30-day mortality rate, followed by extracorporeal liver assist device (ELAD), fractionated plasma separation and adsorption with Prometheus system, molecular adsorbent recirculating system (MARS), Biologic-DT liver dialysis device, and PE+MARS. PE showed the best effect in reducing 90-day mortality rate, followed by Prometheus, ELAD, and MARS. Biologic-DT showed the best effect in improving hepatic encephalopathy, followed by MARS, PE+MARS, and ELAD. Patients undergoing ELAD had the lowest risk of bleeding, and compared with standard medical treatment, Biologic-DT might increase the risk of bleeding [risk ratio=1.9×10 8 , 95% confidence interval: (4.6-6.2)×10 27 ]. Conclusion PE might be the best option for reducing 30- and 90-day mortality rates in ACLF patients. Biologic-DT has a better effect in improving hepatic encephalopathy, but it may increase the risk of bleeding.

2.
Journal of Clinical Hepatology ; (12): 2078-2083, 2022.
Article in Chinese | WPRIM | ID: wpr-942663

ABSTRACT

Objective To investigate the risk factors for intraoperative hypotension (IOH) in patients undergoing double plasma molecular adsorption system (DPMAS) artificial liver support therapy. Methods Clinical data were collected from 181 patients (670 cases in total) who underwent DPMAS artificial liver support therapy in Liver Disease Center of The First Affiliated Hospital of University of Science and Technology of China from October 1, 2017 to December 31, 2020, and according to the presence or absence of IOH during DPMAS therapy, they were divided into IOH group with 70 patients and non-IOH group with 111 patients.Clinical indicators were compared between the two groups and their association with IOH was analyzed; prognosis was analyzed at 12 and 24 weeks.The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors for IOH.The Kaplan-Meier method was used to plot receiver operating characteristic (ROC) curves, and the Z test was used for comparison of the area under the ROC curve (AUC) of independent risk factors. Results The univariate Logistic regression analysis showed that female individuals, individuals aged ≥50 years, and individuals with normal or low body mass index (BMI) tended to have a higher risk of IOH (all P < 0.05), and the multivariate analysis showed that normal or low BMI (odds ratio [ OR ]=3.290, 95% confidence interval [ CI ]: 1.523-7.108, P =0.002) and female sex ( OR =5.146, 95% CI : 2.316-11.432, P < 0.001) were independent risk factor for IOH in patients undergoing DPMAS artificial liver support therapy.The ROC curve analysis of female sex+BMI ≤24 kg/m 2 showed that it had an AUC of 0.639 in predicting IOH ( P =0.002).The patients experiencing IOH had a 12-week survival rate of 55.77%(29/52) and a 24-week survival rate of 50%(26/52), and there were significant differences between the two groups in 12-and 24-week survival rates (12-week: 76.53% vs 55.77%, χ 2 =6.887, P =0.009;24-week: 74.49% vs 50.00%, χ 2 =9.080, P =0.003). Conclusion The risk of hypotension was higher in female patients and that with normal or low BMI during DPMAS artificial liver therapy.Patients with IOH had poor survival prognosis at 24 weeks after DPMAS therapy.

3.
Journal of Clinical Hepatology ; (12): 1188-1191, 2022.
Article in Chinese | WPRIM | ID: wpr-924805

ABSTRACT

Acute-on-chronic liver failure (ACLF) is a disease of rapid deterioration of liver function caused by the acute exacerbation of chronic liver diseases, and it is often associated with multiple organ failure and has a poorer prognosis than common liver cirrhosis. Many studies suggest that timely liver transplantation can significantly improve the survival rate of patients with ACLF; however, there are currently no reliable guidelines that point out the indications for liver transplantation in patients with ACLF. This article summarizes recent studies and discusses the indication, timing, and prognosis of liver transplantation in ALCF patients.

4.
Journal of Clinical Hepatology ; (12): 1053-1058, 2022.
Article in Chinese | WPRIM | ID: wpr-924775

ABSTRACT

Objective To investigate the changing trend of platelet count (PLT) and related influencing factors in patients with hepatitis B virus-related chronic-on-acute liver failure (HBV-ACLF) after artificial liver support system (ALSS) therapy. Methods A total of 152 patients with HBV-ACLF who were hospitalized and treated in The Third Affiliated Hospital of Sun Yat-Sen University from January 2018 to November 2021 were included in the study, among whom 102 patients received plasma exchange (PE) and 50 patients received double plasma molecular absorption system combined with low-dose PE, and their clinical data and laboratory marker were measured. The independent samples t -test or the Mann-Whitney U test was used for the comparison of continuous data between two groups, and the chi-square test was used for the comparison of categorical data between two groups; a multivariate logistic regression analysis was used to investigate the risk factors for PLT > 50×10 9 /L after ALSS therapy; the receiver operating characteristic (ROC) curve was used to investigate the value of baseline PLT in predicting PLT > 50×10 9 /L after ALSS therapy. Results The patients were mostly middle-aged male adults; among the 152 patients, 70 (46.1%) had liver cirrhosis on admission, 114 (75.0%) received three sessions of ALSS therapy, and 88% had a baseline PLT count of > 50×10 9 /L. There was a significant reduction in PLT from baseline to after ALSS therapy (79.5±47.7 vs 112.5±64.1, t =4.965, P 0.05). The multivariate logistic regression analysis showed that cirrhosis (odds ratio [ OR ]=3.097, 95% confidence interval [ CI ]: 1.255-7.645, P =0.014) and PLT > 50×10 9 /L at baseline ( OR =0.019, 95% CI : 0.002-0.154, P 50×10 9 /L after ALSS therapy. The ROC curve analysis of baseline PLT showed that PLT > 80.5×10 9 /L at baseline was the optimal cut-off value affecting PLT > 50×10 9 /L after treatment, with an area under the ROC curve of 0.818. Conclusion The influence of ALSS therapy on PLT is temporary, but cirrhotic patients have a weaker PLT generation ability than non-cirrhotic patients. PLT > 80.5×10 9 /L at baseline is the optimal cut-off value to reduce the risk of bleeding after ALSS therapy.

5.
Journal of Clinical Hepatology ; (12): 2802-2807, 2021.
Article in Chinese | WPRIM | ID: wpr-906866

ABSTRACT

Objective To observe the 24-week survival status of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE) and double plasma molecular adsorption system (DPMAS) alone or in combination, and to establish a predictive model for 24-week prognosis. Methods Related clinical data were collected from 133 patients with HBV-ACLF who received PE and DPMAS alone or in combination in The Affiliated Provincial Hospital of Anhui Medical University from January 2015 to December 2019, and according to the survival status at the 24-week follow-up after treatment, they were divided into survival group with 71 patients and death group with 62 patients. A total of 55 patients with HBV-ACLF who received PE and DPMAS alone or in combination in The Second Affiliated Hospital of Anhui Medical University from January 2018 to January 2020 were enrolled as validation group to validate the performance of the model. Related clinical data included mode of artificial liver support therapy, age, sex, total bilirubin (TBil), international normalized ratio (INR), creatinine (Cr), serum sodium, platelet count (PLT), albumin (Alb), and presence or absence of ascites, hepatorenal syndrome, hepatic encephalopathy, and gastrointestinal bleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. The Cox regression model was used to analyze the influencing factors for the prognosis of HBV-ACLF patients after PE and DPMAS alone or in combination and establish a predictive model; the receiver operator characteristic (ROC) curve was plotted and the DeLong method was used to compare the area under the ROC curve (AUC) between the new predictive model and Model for End-Stage Liver Disease (MELD)/MELD combined with serum sodium concentration (MELD-Na) scores. Results At 24 weeks after treatment, 71 patients survived and 62 patients died in the modeling group. The Cox regression analysis showed age (hazard ratio [ HR ]=1.030, P =0.013), TBil ( HR =1.018, P < 0.001), INR ( HR =1.517, P < 0.001), and PLT ( HR =0.993, P =0.04) were independent influencing factors for 24-week survival. According to the results of the Cox regression analysis, a prognostic model for HBV-ACLF patients treated with PE and DPMAS alone or in combination was established as ATIP=0.029×age (years)+0.018×TBil (mg/dL)+0.417×INR-0.007×PLT (10 9 /L). Both the modeling group and the validation group showed that the ATIP model had a better predictive performance than MELD and MELD-NA scores(all P < 0.05). Conclusion Age, TBil, INR, and PLT are independent influencing factors for the 24-week survival of HBV-ACLF patients treated with PE and DPMAS alone or in combination, and the ATIP model has a good performance in predicting the 24-week prognosis of HBV-ACLF patients treated with PE and DPMAS alone or in combination.

6.
Journal of Clinical Hepatology ; (12): 2696-2700, 2021.
Article in Chinese | WPRIM | ID: wpr-905024

ABSTRACT

Acute-on-chronic liver failure (ACLF) is a life-threatening disease with a high risk of multiple organ failure, sepsis, and death. ACLF activates innate and acquired immune responses in human body and thus leads to the progression of persistent systemic inflammatory response syndrome and multiple organ dysfunction, leading to the high mortality rate of this disease. Dysregulated immune response plays a key role in disease progression, and immunotherapy may help to target immune-mediated organ damage and inhibit the progression of liver failure. This article reviews the role and mechanism of drugs and means with a potential immune regulatory effect in ACLF, in order to provide a reference for immunotherapy for ACLF.

7.
Article in Chinese | WPRIM | ID: wpr-862543

ABSTRACT

End-stage liver cirrhosis usually refers to chronic liver failure caused by decompensated liver cirrhosis and brings a heavy burden to human health. Liver transplantation is the most effective treatment, but its clinical application is limited by the shortage of liver source and high cost. Artificial liver support system is often used as bridging therapy to liver transplantation. The development of cell therapy brings new hope to this disease. This article summarizes the etiological treatment of end-stage liver cirrhosis and the management of related complications and introduces the indications and timing for artificial liver support system, cell therapy, and liver transplantation in patients with end-stage liver cirrhosis.

8.
Journal of Clinical Hepatology ; (12): 2115-2118, 2020.
Article in Chinese | WPRIM | ID: wpr-829184

ABSTRACT

Non-bioartificial liver is one of the important means for the treatment of liver failure and has been increasingly recognized in recent years, and meanwhile, it has also been widely used in non-liver failure diseases .This article reviews the application of non-bioartificial liver in the treatment of some non-liver failure diseases, including refractory pruritus caused by cholestasis, “cytokine storm” caused by various viral infections, hyperlipidemia, thyroid storm, and nervous system diseases, so as to provide a reference for clinical practice.

9.
Journal of Clinical Hepatology ; (12): 2005-2009, 2020.
Article in Chinese | WPRIM | ID: wpr-829166

ABSTRACT

ObjectiveTo investigate the effect of artificial liver support therapy on the short-term (28- and 90-day) mortality rate of patients with liver failure in the plateau stage through a stratified analysis based on Model for End-Stage Liver Disease (MELD) score. MethodsA retrospective analysis was performed for 187 patients with liver failure who were admitted to Nanfang Hospital, Southern Medical University, from January 2015 to April 2019, with 73 patients in the artificial liver group and 114 in the non-artificial liver group. The stratified analysis based on MELD score in the plateau stage was performed to investigate the differences in 28- and 90-day mortality rates, hospital costs and length of hospital stay of surviving patients, and incidence rate of adverse reactions of artificial liver support therapy between the two groups. The t-test was used for comparison of continuous data between the two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between the two groups. ResultsCompared with the non-artificial liver group, the artificial liver group had a significant reduction in the 28-day mortality rate of the patients with an MELD score of 30-39 (5.9% vs 39.6%, P<0.001) or those with an MELD score of 40 (25.0% vs 72.7%, P<0.05). Compared with the non-artificial liver group, the artificial liver group had a significant reduction in the 90-day mortality rate of the patients with an MELD score of 30-39 (23.5% vs 623%, P<0.001). Artificial liver support therapy did not significantly shorten the mean hospital stay of the surviving patients (P>0.05) and had no significant influence on the total hospital costs of the surviving patients within 90 days (P>0.05). The incidence rate of adverse reactions related to artificial liver support therapy was 29.1%, but the symptoms were mild and were relieved after symptomatic treatment. ConclusionPatients with an MELD score of <30 in the plateau stage tend to have low 28- and 90-day mortality rates, and artificial liver support therapy can be reasonably selected according to the patient’s economic conditions and willingness. Artificial liver support therapy is recommended for patients with an MELD score of 30-39 in the plateau stage if there is no obvious contraindication. For patients with an MELD score of 40 in the plateau stage, artificial liver support therapy is recommended within 28 days if there is no obvious contraindication, and liver transplantation is recommended as soon as possible. Artificial liver support therapy has no significant influence on the total hospital costs and mean hospital stay of the surviving patients within 90 days and does not increase the economic burden of patients.

10.
Journal of Clinical Hepatology ; (12): 823-828, 2020.
Article in Chinese | WPRIM | ID: wpr-819188

ABSTRACT

ObjectiveTo systematically review the clinical of artificial liver support system (ALSS) in the treatment of drug-induced liver failure. MethodsPubMed, Embase, The Cochrane Library, CMB, CNKI, and VIP databases were searched for related randomized controlled trials or randomized controlled trials on ALSS in the treatment of drug-induced liver failure published up to October 2019, and a statistical analysis was performed. Odds ratio (OR) was the effect size for categorical data, and the difference between groups was the effect size for continuous data. The weighted mean difference (WMD) method was used for the pooled analysis of effect size, and 95% confidence interval (CI) was calculated for each effect size. I2 and P values were used to evaluate the heterogeneity of the articles included in the analysis; a fixed effect model was used when I2<50% and P>0.1, otherwise a random effects model was used. ResultsA total of 16 articles with 945 patients were included, with 520 patients in the ALSS+routine medical treatment (RMT) group and 425 in the RMT group. The meta-analysis showed that compared with the RMT group, the ALSS+RMT group had a significantly lower mortality rate of drug-induced liver failure (OR=0.27, 95%CI: 0.20-0.36, P<0.001), significant improvements in albumin (Alb) (MD=1.21, 95%CI: 0.18-2.25, P=0.02) and prothrombin activity (PTA) (MD=11.84, 95%CI: 6.34-17.35, P<0.001), and a significant reduction in total bilirubin (TBil) (MD=-104.97, 95%CI: -163.63 to -46.30, P<0.001). Further analysis of Alb, TBil, and PTA after the withdrawal of ALSS showed that ALSS significantly improved Alb (MD=1.74, 95%CI: 1.20-2.27, P<0.001) and PTA (MD=4.45, 95%CI: 2.80-6.10, P<0.001) and significantly reduced TBil (MD=-128.41, 95%CI: -217.22 to -39.59, P=0.005). ConclusionCompared with RMT alone, RMT combined with ALSS can significantly improve the main biochemical indicators of patients with drug-induced liver failure and reduce their mortality rate.

11.
Article in Chinese | WPRIM | ID: wpr-824367

ABSTRACT

The levels of M30 and M65 in the improvement group,non-recovered group and control group were significantly different before the first ALSS therapy(F=109.36 and 90.42,respectively,both P<0.01).The levels of M30 and M65 were not significantly different between improvement group and non-recovered group before treatment(t=0.836 and 0.286,respectively,both P>0.05).However,after twice ALSS therapy,the levels of M30 and M65 in non-recovered group were significantly higher than those in improvement group(t=30.699 and 64.777,respectively,both P<0.01).Moreover,after the second ALSS therapy,the levels of M30 and M65 were both significantly lower compared to those after the first-time therapy in the improvement group(t=3.350 and 5.932,respectively,both P<0.01).The areas under Curve(AUC)of M30,M65 and the combination of M30 and M65 for prognosis prediction were 0.796,0.844 and 0.906,respectively.The AUC of combination of M30 and M65 was significantly higher than M30 or M65 alone(Z=2.163 and 2.141,respectively,P=0.031 and 0.032,respectively).The cut-off values of M30 and M65 were 591.91 and 924.50 U/L,respectively.The sensitivity and specificity of combined M30 and M65 were 94.7%and 82.5%,respectively.Conclusions Serum M30 and M65 levels can predict the short-term prognosis of HBV-ACLF patients after ALSS therapy.The combination of M30 and M65 is of better diagnostic value.

12.
Article in Chinese | WPRIM | ID: wpr-800732

ABSTRACT

Objective@#To analyze the dynamic changes of serum M30 and M65 levels in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) during artificial liver support system(ALSS) therapy, and to explore their predictive efficiency and clinical values for short-term prognosis of HBV-ACLF.@*Methods@#Seventy-six patients with HBV-ACLF who underwent ALSS therapy for the first time from May 2016 to May 2019 in the First Hospital of Jiaxing were selected.The patients were divided into improvement group (38 cases) and non-recovered group (38 cases)according to their prognosis, and 38 healthy persons were selected as control group during the same period.The serum levels of M30 and M65 were detected by enzyme-linked immunosorbent assay(ELISA). The predictive values of M30 and M65 levels for short-term prognosis in patients receiving ALSS were calculated by receiver operating characteristic analysis curve (ROC). M30 and M65 levels before and after ALSS were compared by two-way repeated measures analysis of variance.@*Results@#The levels of M30 and M65 in the improvement group, non-recovered group and control group were significantly different before the first ALSS therapy (F=109.36 and 90.42, respectively, both P<0.01). The levels of M30 and M65 were not significantly different between improvement group and non-recovered group before treatment (t=0.836 and 0.286, respectively, both P>0.05). However, after twice ALSS therapy, the levels of M30 and M65 in non-recovered group were significantly higher than those in improvement group (t=30.699 and 64.777, respectively, both P<0.01). Moreover, after the second ALSS therapy, the levels of M30 and M65 were both significantly lower compared to those after the first-time therapy in the improvement group (t=3.350 and 5.932, respectively, both P<0.01). The areas under curve (AUC) of M30, M65 and the combination of M30 and M65 for prognosis prediction were 0.796, 0.844 and 0.906, respectively. The AUC of combination of M30 and M65 was significantly higher than M30 or M65 alone (Z=2.163 and 2.141, respectively, P=0.031 and 0.032, respectively). The cut-off values of M30 and M65 were 591.91 and 924.50 U/L, respectively. The sensitivity and specificity of combined M30 and M65 were 94.7% and 82.5%, respectively.@*Conclusions@#Serum M30 and M65 levels can predict the short-term prognosis of HBV-ACLF patients after ALSS therapy.The combination of M30 and M65 is of better diagnostic value.

13.
Chinese Journal of Hepatology ; (12): 51-55, 2019.
Article in Chinese | WPRIM | ID: wpr-810372

ABSTRACT

Objective@#To investigate the effects of two different sorbents(Carbon perfusion apparatus and Resin perfusion apparatus)in Double plasma molecular absorb syetem for liver failure treatment.@*Methods@#A total of 152 cases with liver failure who were admitted to The Sixth People's Hospital of Zhengzhou, from June 2016 to May 2018 were selected and divided into DPMARS Carbon group (77 cases) and Resin group (75 cases). The two groups were observed in terms of liver function, prothrombin activity(PTA),Plasma albumin ,tumor necrosis factor alpha and interleukin-6 were detected and compared between the two groups before and after treatment.@*Results@#①The clinical symptoms improved in different degree in two groups, the recovery rate of Carbon cans Carbon perfusion apparatus group and Resin group separately were89.6% (69/77)、90.7% (68/75)(χ2 = 0.048, P = 0.975), there were no statistical differences. There were no statistical differences between the two groups in untoward reactions(χ2 = 0.235, P = 0.995), ②Compared with before treatment, TBil(t = 3.735, 3.728; P = 0.000, 0.000)、ALT(t = 5.117, 5.203; P = 0.000, 0.000)、TNF-α (t = 3.158, 3.094; P = 0.000, 0.002)、IL-6(t = 3.647, 3.559; P = 0.002, 0.003)decreased and ALB (t = 2.300, 3.065; P = 0.024, 0.003) increased significantly after treatment in both groups, and there were statistical differences. There were no signifiant differences in the changes in ALB(t = 0.316, 0.209; P = 0.657, 0.720) and PTA(t = 0.810, 0.843; P = 0.429, 0.516). ③After treatment, there were no signifiant differences in the changes in TBil、ALT、ALB、PTA、TNF-α、IL-6(t = 0.377、0.904、-1.133、-1.552、0.841、0.401; P = 0.952、0.283、0.826、0.094、0.154、0.457).@*Conclusion@#Double plasma molecular absorb syetem is effective in treating liver failure. Carbon perfusion apparatus or Resin perfusion apparatus can be combined with Specific bilirubin adsorption column for DPMARS in clinical treatment,and their effects are similar.

14.
Article in Chinese | WPRIM | ID: wpr-743884

ABSTRACT

BACKGROUND: Double plasma molecular adsorption system cannot only specifically absorb bilirubin and bile acids, but also eliminate toxins, inflammatory transmitters and cytokines in the body. In the absence of plasma or in the case of plasma deficiency, it can effectively remove harmful substances, prevent multiple organ failure and fight for time for the liver regeneration and recovery of liver function, which is suitable for liver failure caused by various reasons. OBJECTIVE: To compare the validity and safety of double plasma molecular adsorption system combined with plasma exchange and simple plasma exchange in the treatment of liver failure. METHODS: Sixty patients with liver failure admitted to the Guizhou Provincial People's Hospital from October 2014 to October 2017 were included and randomized into two groups (n=30/group) . Plasmapheresis was used in plasma exchange group, and the volume of plasma exchanged was 2 500-3 000 mL. The combination treatment group was treated by double plasma molecular adsorption system combined with plasma exchange, and the volume of plasma exchanged was 1 000-1 500 mL. In the two groups, the clinical effects and liver function were evaluated after three treatment sessions, and adverse reactions were observed during the artificial liver treatment. RESULTS AND CONCLUSION: After treatment, the levels of serum total bilirubin and alanine aminotransferase were significantly lower than those before treatment, and the prothrombin activity was significantly higher than that before treatment (P < 0.05) . However, the serum albumin level showed no significant difference in the combination treatment group before and after treatment. Compared with the plasma exchange group, the post-treatment levels of serum total bilirubin, alanine aminotransferase and serum albumin were significantly lower in the combination treatment group, and the prothrombin activity was significantly higher (P < 0.05) . (2) The total effective rate of the combination treatment group (83%) was significantly higher than that of the plasma exchange group (63%) (P < 0.05) . (3) During the artificial liver treatment, there was one case of rash, one case of chills and one case of hypotension in the combination group, while no adverse reaction occurred in the plasma exchange group. (4) To conclude, either double plasma molecular adsorption combined with plasma exchange or simple plasma exchange can markedly improve the liver function of patients with liver failure, and produce few adverse reactions. However, the combination of double plasma molecular adsorption and plasma exchange has an advantageous therapeutic effect and can reduce plasma consumption.

15.
Article in Chinese | WPRIM | ID: wpr-697069

ABSTRACT

Objective To survey the factors associated with deep venous thrombosis after artificial liver treatment in patients with liver failure. Methods A retrospective survey was used in our hospital from January 2014 to December 2016 consecutive liver failure patients by artificial liver treatment, collected patient data, including general demographic information, medical history. Results Medical history data were collected from 189 compliance cases, including deep venous thrombosis group (11 cases),no deep venous thrombosis group(178 cases),and 5.82%(11/189)of deep vein thrombosis.There were significant differences in age(χ2=7.17, P=0.027), catheterization(χ2=4.99, P=0.025), number of successful venipuncture(χ2=10.856, P=0.004),artificial liver frequency(χ2=67.481, P<0.01), activity status(χ2=9.607, P=0.022), D-dimer(t=12.318, P<0.01), infection(χ2=17.231, P=0.001)and other factors in thrombosis group and thrombus group(P<0.05).Logistic regression showed that age(OR=1.643, P=0.01),activity status(OR=1.643,P=0.01),number of successful venipuncture(OR=6.049,P<0.01),D-dimer(OR=2.532, P=0.005)and infection(OR=2.463, P=0.008)were independent risk factors for thrombosis. Conclusions Deep vein thrombosis after artificial liver injury in liver failure is not uncommon, and the prevention of deep vein thrombosis after artificial liver surgery is strengthened, especially for elderly, absolute bed, venous puncture injury patients, elevated D-dimer and infected patients.

16.
Journal of Clinical Hepatology ; (12): 1847-1854, 2018.
Article in Chinese | WPRIM | ID: wpr-778994

ABSTRACT

Liver failure is a serious stage in the development of various liver diseases, with rapid progression, critical conditions, and a high mortality rate. Artificial liver can eliminate toxic substances in the body, supplement essential substances, and create opportunities for hepatocyte regeneration and liver function recovery, and in addition, it can also prolong the waiting time for liver transplantation and thus acts as a bridge to liver transplantation. However, the wide application of artificial liver is facing many difficulties nowadays, such as shortage of blood sources, difficulties in cell sources, a lack of satisfactory effects, and high costs, and therefore, artificial liver treatment needs innovation and improvement. New non-bioartificial liver systems developed in recent years, such as double plasma molecular absorption system, molecular absorbent recirculating system, continuous albumin purification system, and plasma diafiltration, can help to achieve a good clinical outcome and meanwhile reduce the amount of plasma used and minimize side effects. Biological artificial liver and hybrid artificial liver systems have the functions of specific detoxification, biosynthesis, and transformation and thus have great potential in clinical application, which is limited by cell source, cell culture, and bioreactor. This article elaborates on the current status and advances in the application of artificial liver in the treatment of liver failure and provides research directions for the development of artificial liver.

17.
Chinese Journal of Surgery ; (12): 957-959, 2017.
Article in Chinese | WPRIM | ID: wpr-809648

ABSTRACT

Liver failure is a serious stage during liver disease development of which mobidity is high. There is no effective treatment at present.Artificial liver support system is one of the important methods to treat liver failure which includes non-biological artificial liver, biological artificial liver and hybrid artificial liver. Among the artificial liver devices. The bioartificial liver is the most similar artifical liver device to human liver in terms of detoxification, synthesis and metabolism currently.The complexity of human liver function makes the biological artificial liver facing great challenges in selection of liver seed cells, construction of bioreactor and the best combination with auxiliary device, which leads to the slow development of bioartificial liver. In order to provide theoretical support for the study of bioartificial liver, the current status and its development are reviewed in the following aspects, the source of seed cells, the construction of bioreactor, the combination of auxiliary devices and the clinical application of bioartificial liver in this article.

18.
Chinese Journal of Hepatology ; (12): 646-650, 2017.
Article in Chinese | WPRIM | ID: wpr-809285

ABSTRACT

Liver failure is a common clinical syndrome of serious liver diseases with a high mortality rate. Artificial liver support system can significantly reduce the mortality rate of patients with liver failure and is widely used in clinical practice. Due to the shortage of blood resource, the increase in blood-borne diseases, increased demands for liver transplantation, and the change in treatment concepts, single non-biological artificial liver treatment is often unable to satisfy clinical needs, and it is urgent to develop new therapeutic paradigms of non-bioartificial liver. This article reviews the changes and perspectives of non-biological artificial liver in the treatment of liver failure.

19.
Chinese Journal of Hepatology ; (12): 94-99, 2017.
Article in Chinese | WPRIM | ID: wpr-808210

ABSTRACT

Liver failure has various clinical types, a complex pathogenesis, and rapid disease progression, as well as a high mortality rate. Liver failure caused by hepatitis B virus infection is the most common type in China with severe conditions, various complications, and a mortality rate as high as 40%-90%. Invasive fungal disease secondary to acute-on-chronic liver failure can affect patients’ prognosis and increase mortality rate. This article introduces the research advances in hepatitis B-related liver failure, artificial liver, and invasive fungal disease secondary to acute-on-chronic liver failure in 2016.

20.
Journal of Clinical Hepatology ; (12): 1617-1620, 2017.
Article in Chinese | WPRIM | ID: wpr-661717

ABSTRACT

Severe liver diseases such as liver failure and acute decompensated cirrhosis have critical conditions and high mortality rates,and the prognosis of such patients is closely associated with early warning,timely dynamic assessment,and comprehensive and effective therapy.The patients require a series of effective clinical management measures for elimination of causative factors,organ support,and prevention and treatment of complications.Medical treatment-artificial liver-liver transplantation is an important modality for severe liver diseases.Granulocyte colony-stimulating factor,stem cell therapy,and bioartificial liver have a promising future,while there are still controversies over non-selective β-blocker.This article reviews the hotspots in the clinical management of severe liver diseases.

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