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肝脏在维持全身器官自稳状态中发挥关键作用,严重肝损害所致暴发性肝衰竭(fulminant hepatic failure,FHF)极易引发各器官功能瓦解,导致多器官衰竭。FHF 常规内科治疗效果极差,尽管监护技术进步和支持疗法改善,病死率仍在65%～90%,Ⅳ期肝性脑病的 FHF 患者病死率高达90%～95%。当前以肝移植治疗 FHF 效果最佳,病死率可降至20%,然而供体肝来源很少,往往因等待供体肝而延误肝移植的时机,结果在等待肝移植期间90%的 FHF 病人发展成不可逆性脑损伤或多器官衰竭而最终死亡。目前已把注意力集中在研制新型生物人工肝支持系统(bioartificial liver support system,BLSS)方面,旨在为肝移植争取宝贵的时间;某些 FHF 病人经 BLSS 治疗使肝脏获得充分的再生,也有希望完全避免肝移植而存活。本文着重阐述 BLSS 的概念和研制 BLSS 治疗 FHF 的重要性,而不讨论具体技术问题。
The liver plays a key role in maintaining the stability of the whole body organs. Fulminant hepatic failure (FHF) caused by severe liver damage can easily lead to the disintegration of various organ functions, resulting in multiple organ failure. FHF conventional medical treatment is very poor, and despite improved monitoring techniques and supportive care, mortality is still 65% to 90%, Ⅳ FHF hepatic encephalopathy patients mortality as high as 90% to 95%. At present, liver transplantation is the best treatment for FHF, and the mortality rate can be reduced to 20%. However, donor liver sources are rare, and the timing of liver transplantation is often delayed by waiting for the donor liver. As a result, while waiting for liver transplantation, 90% of FHF patients Develop into irreversible brain injury or multiple organ failure and eventually die. At present, attention has been focused on the development of a new bioartificial liver support system (BLSS), which is aimed at gaining valuable time for liver transplantation. Some patients with FHF have sufficient regeneration of the liver through BLSS treatment. There is also hope Completely avoid liver transplantation and survival. This article focuses on the concept of BLSS and the importance of developing BLSS for the treatment of FHF without discussing specific technical issues.