Assessment of bilirubin clearance capacity of a newly developed ion‐exchange adsorption column and its possible use as a supportive therapy in hepatorenal syndrome
Assessment of bilirubin clearance capacity of a newly developed ion‐exchange adsorption column and its possible use as a supportive therapy in hepatorenal syndrome
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新开发的离子交换吸附柱的胆红素清除能力评估及其作为肝肾综合征支持疗法的可能性
DOI：
10.1002/jca.2920050302
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发表时间：
1990
影响因子：
1.5
通讯作者：
M. Sasaki
中科院分区：
文献类型：
--
作者：
J. Sone;T. Saibara;H. Himeno;K. Yamasaki;K. Miyamoto;T. Maeda;S. Onishi;Yasutake Yamamoto;Keunsik Park;T. Okumiya;M. Sasaki
我们在体外评估了三种不同类型装置的胆红素降低能力：用于双重过滤血浆置换（DFP）的高渗透膜柱（Evaflux 2A，日本可乐丽）、用于血液灌流（HP）的无涂层活性炭柱（N-180，Asahi Medical，日本）和用于血浆吸附的离子交换柱（PA）（BR-350，Asahi Medical，日本） B-001，可乐丽，日本）。 DFP 柱以白蛋白依赖性方式有效降低血浆胆红素和胆汁酸等低分子蛋白质的浓度。木炭柱优先吸附低分子物质。但在这两个柱中，纤维蛋白原的损失是确定处理血浆体积的限制因素。与δ胆红素和非结合胆红素相比，PA 离子交换柱更有效地吸附胆汁酸、解离胆红素和单结合胆红素。用肝素对柱进行预处理，将纤维蛋白原的损失减少到 10% 以下。我们在体内应用 BR-350 离子交换柱治疗三名高胆红素血症患者。一名患有肝肾综合征（HRS）的酒精性肝炎患者经过治疗后，急性肾功能衰竭痊愈。然而，在原发性胆汁性肝硬化患者和暴发性肝炎患者中，血清胆红素的降低是短暂的，没有发现明显的有益反应。 BR-350柱吸附血浆胆红素的容量和能力足以治疗深度黄疸患者，因为能够连续处理初始总胆红素浓度为108 mg/dl的患者的4升血浆，而胆红素吸附能力没有明显下降。因此，该柱与透析相结合可能最适用于降低 HRS 中的血清胆红素浓度。
We assessed the bilirubin reduction capacity of three different types of devices in vitro: a high‐permeable membrane column for double‐filtration plasmapheresis (DFP) (Evaflux 2A, Kuraray, Japan), and non‐coated charcoal column for hemoperfusion (HP) (N‐180, Asahi Medical, Japan), and ion‐exchange columns for plasma adsorption (PA) (BR‐350, Asahi Medical, Japan, and B‐001, Kuraray, Japan). A column for DFP reduced the concentration of lowmolecular proteins effectively such as plasma bilirubin and bile acids in an albumin‐dependent manner. A charcoal column adsorbed low‐molecular substances preferentially. But in these two columns, the loss of fibrinogen is a limiting factor for determining the processing plasma volume. Ion‐exchange columns for PA adsorbed bile acids, disconjugated bilirubin, and monoconjugated bilirubin more efficiently compared with delta‐bilirubin and unconjugated bilirubin. Pretreatment of the column with heparin reduced the loss of fibrinogen to less than 10%. We applied the BR‐350 ion‐exchange column in vivo for treatment of three patients with hyperbilirubinemia. After treatment, an alcoholic hepatitis patient with the hepatorenal syndrome (HRS) recovered from acute renal failure. However, in a patient with primary biliary cirrhosis and in a patient with fulminant hepatitis, the decrease of serum bilirubin was transient and no obvious beneficial responses were noted. The capacity and ability of the BR‐350 column to adsorb plasma bilirubin was shown sufficient to treat deeply jaundiced patients, because 4 liters of the plasma of a patient with 108 mg/dl of initial total bilirubin concentration was able to be processed continuously without an obvious decrease in bilirubin adsorption capacity. Therefore, this column in combination with dialysis may be most applicable in lowering serum bilirubin concentration in the HRS.