血漿交換排液浄化循環透析(劇症肝炎)(<特集>アフェレシス療法における新しいmodality)

概要

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Background: We developed a plasma recycling dialysis (PRD) system based on plasma exchange (PE). In this system, rapid reduction of toxic substances and restitution of deficient essential substances are performed by PE and subsequent blood purification is performed by dialysis between separated plasma recycled over a purification device and the patient's blood across the membrane of the plasma separator. To demonstrate the safety and efficacy of this system, we used a pig model of drug-induced fulminant hepatic failure (FHF). Methods: Three groups of animals were studied. Group 1: diseased control group (n=5). Group 2: PE group (n=6). Sixteen hours after drug infusion, pigs underwent PE, approx. 1.2L for 2h. Group 3: PE+PRD group (n=5). Pigs underwent PE followed by PRD for 6h. Results: In Group 3, the values of ammonia, total bile acid, and total bilirubin continuously decreased and were significantly lower than those of group 2 24h after the induction of FHF. The Fisher ratio was significantly higher than that for group 2 after 24h. Conclusions: The safety of this PE-based PRD system was demonstrated and removal of toxic substances was significant. This study confirmed the clinical utility of this system as an artificial liver support.
日本アフェレシス学会の論文
2009-10-31