分子吸附循环系统(MARS)人工肝治疗对重症肝炎单核细胞免疫功能的影响  

Effects of molecular adsorbent recirculating system(MARS) on immune function of monocytes in the patients with severe hepatitis

作　　者：刘拉羊[1] 赵良[2] 孙晓娟[1] 邓红[1] 

机构地区：[1]西安交通大学第二医院感染科,陕西西安710004 [2]西安交通大学第一医院感染科,陕西西安710061

出　　处：《中国急救医学》2005年第12期869-872,共4页Chinese Journal of Critical Care Medicine

基　　金：陕西省自然科学基金(No.2004C266)

摘　　要：目的观察和评价分子吸附循环系统(MARS)人工肝治疗重症肝炎过程中对单核细胞免疫功能的影响。方法16例重症肝炎均采用MARS人工肝治疗,每次治疗8 h,在治疗前、治疗结束时及治疗后48、72 h各取肝素抗凝血15 mL,分离单核细胞,脂多糖(LPS)(10μg/mL)刺激12 h,ELISA方法测定其分泌的细胞因子(TNF-α、IL-6、IL-10)水平;测定单核细胞人类白细胞DR抗原(HLA-DR)的表达情况,判断其抗原呈递功能(流式细胞仪),同时观察外周血淋巴细胞、单核细胞计数及血浆各种细胞因子水平的变化。结果①单核细胞分泌功能:MARS人工肝治疗前,重症肝炎病人单核细胞分泌功能升高,MARS人工肝治疗后,单核细胞分泌TNF-α、IL-6、IL-10减少。②单核细胞抗原呈递功能:与正常人相比较,重症肝炎病人抗原呈递功能下降,MARS人工肝治疗后单核细胞抗原呈递功能明显改善。③应用MARS人工肝治疗后,血浆TNF-α、IL-6、IL-10水平明显下降。结论①应用MARS人工肝治疗可明显改善重症肝炎的免疫功能紊乱。②单核细胞表达HLA-DR及血浆TNF-α、IL-6、IL-10水平是反映机体免疫状态和判断预后的良好指标。③接受MARS人工肝治疗的时间及其间隔时间是影响治疗结果的重要因素,治疗越早,效果越好。Objective To evaluate the effects of MARS on immune function of monocytes in the patients with severe hepatitis. Methods 16 patients with severe hepatitis were enrolled in this study. All the patients underwent MARS for 8 hours. The blood was taken from those patients before treatment, at the end of the treatment, 48, 72 h after MARS. The monocytes were isolated in blood ,and incubated with LPS 10μg/mL for 12 hours at 37℃. In order to determine the secretion of monocytes, the levels of TNF - α, IL- 6 and IL - 10 in supematants were determined by ELISA. The antigen presenting function represented by HLA- DR expression was detected by flow cytometry analysis. Plasma TNF- α, IL- 6 and IL- 10 were tested simultaneously. Results ①before MARS, cytokines secreted from monocytes in severe hepatitis were higher. After MARS, there were significant reduction of TNF- α,IL- 6 and IL- 10 secreted from monocytes in patients. ②Compared with nonnals, the HLA- DR expression of the monocytes in all the patients was significantly lower, which was improved with MARS therapy. ③After MARS treatment, there were significant reduction of plasma levels of TNF - α, IL- 6 and IL - 10. Conclusions ① The abnormalities of immune system in the patients with severe hepatitis can be improved after MARS therapy. ② The levels of TNF - α, IL - 6 and IL- 10 and HLA - DR as the indicators to estimate the status of immune system and the severity of the disease may be useful. ③The time of MARS treatment is one of the most important factors which have an effect on MARS treatment. The earlier the time of MARS treatment is, the better the outcome is.

关 键 词：重症肝炎 单核细胞功能 血液净化 

分 类 号：R575.1[医药卫生—消化系统]