Lọc gan trong suy gan cấp tính trên nền suy gan mãn tính: triển vọng hiện tại và tương lai

Hepatology International - Tập 8 - Trang 505-513 - 2014
Rakhi Maiwall1, Jaswinder Singh Maras2, Suman Lata Nayak3, Shiv Kumar Sarin1
1Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
2Department of Research, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
3Department of Nephrology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India

Tóm tắt

Bệnh nhân bị suy gan cấp tính trên nền suy gan mãn tính (ACLF) được biết đến với tỷ lệ tử vong rất cao do phần lớn những bệnh nhân này phải chịu đựng sự thất bại đa tạng. Ghép gan vẫn là lựa chọn duy nhất cho những bệnh nhân này; tuy nhiên, có những vấn đề liên quan đến tính khả dụng, chi phí và các biến chứng cũng như tác dụng phụ liên quan đến việc ức chế miễn dịch. Khác với bệnh gan mất bù giai đoạn tiến triển, có khả năng tái tạo và phục hồi gan ở những bệnh nhân mắc ACLF. Một hệ thống hỗ trợ gan, có thể là dựa trên tế bào hoặc không dựa trên tế bào, có khả năng cung cấp hỗ trợ chức năng tạm thời cho đến khi gan hiến tặng có sẵn hoặc gan đang suy giảm sống sót qua sự tấn công của cú sốc cấp tính và tự tái tạo. Hiểu rõ cơ chế bệnh sinh của suy gan và tái tạo rất cần thiết để xác định nhu cầu cho một hệ thống hỗ trợ. Việc loại bỏ các chuyển hóa gan độc hại và thuốc ức chế tái tạo gan bằng cách lọc gan, một hình thức hỗ trợ gan không dựa trên tế bào, có thể giúp tạo ra một môi trường vi mô phù hợp và hỗ trợ gan đang suy yếu. Các hệ thống hiện tại, như MARS và Prometheus, đã không cho thấy lợi ích về sống còn ở những bệnh nhân mắc ACLF, dựa trên đó, những thiết bị mới với chức năng cải tiến hiện đang được phát triển. Tuy nhiên, cần có các thử nghiệm ngẫu nhiên lớn hơn để chứng minh liệu các thiết bị này có thể phục hồi hệ thống miễn dịch phức tạp bị rối loạn và ảnh hưởng đến sự suy tạng và tỷ lệ tử vong ở những bệnh nhân này hay không.

Từ khóa

#suy gan cấp tính #suy gan mãn tính #ghép gan #hỗ trợ gan #lọc gan #cơ chế bệnh sinh #tái tạo gan #miễn dịch

Tài liệu tham khảo

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