成人肝移植围手术期多器官功能障碍综合征患者血清细胞因子的变化  

Alteration in serum cytokines of patients with multiple organ dysfunction syndrome after liver transplantation

作　　者：沈中阳[1] 刘懿禾[1] 王峪[1] 刘蕾[1] 明宇[1] 

机构地区：[1]天津市第一中心医院移植中心,300192

出　　处：《中国危重病急救医学》2007年第1期28-30,共3页Chinese Critical Care Medicine

基　　金：天津市科技发展计划项目（05ZHTGCG00300）

摘　　要：目的探讨应用免疫抑制剂对肝移植围手术期多器官功能障碍综合征（MODS）患者血清细胞因子变化的影响。方法采用放射免疫分析法测定53例成人原位肝移植术（OLT）后MODS患者血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）、IL-8和IL-10水平；并按照是否接受了床旁持续血液净化（CBP）治疗分为治疗组和对照组，比较两组患者血清细胞因子变化及重症加强治疗病房（ICU）住院时间、病死率和ICU治疗费用。结果53例患者发生MODS后血清TNF-α、IL-6、IL-8和IL-10水平均较正常参考值显著升高（P均＜0．05）；其中接受CBP治疗后血清TNF—α、IL-6和IL-8水平均较治疗前显著降低（P均＜0．05），而血清IL-10水平则与治疗前持平。治疗组患者的ICU住院时间较对照组明显延长,ICU治疗费用也明显增加，差异均有显著性（P＜0．05或P＜0．01），但两组间病死率无明显差异。结论术后应用免疫抑制剂可导致成人肝移植围手术期MODS患者机体促炎／抗炎反应失衡，以抗炎因子过度释放为主。CBP治疗可降低血清促炎因子水平，是有效的支持治疗手段。Objective To explore the serum organ dysfunction syndrome （MODS） during the （OLT） to guide the clinical treatment. Methods cytokine fluctuation in those adult patients with multiple post-operation stage of orthotopic liver transplantation Serum levels of tumor necrosis factor - α （TNF - α）, interleukin- 6 （IL -6）, IL- 8 and IL- 10 were determined in 53 MODS patients who had received OLT. They were divided into two groups as control group and experimental group, according to whether continuous blood purification （CBP） had been performed or not. The levels of serum cytokines and intensive care unit （ICU） stay time, intubation time, mortality and ICU expenses were compared between the two groups. Results The levels of serum TNF - α, IL - 6 and IL - 8 rose, while that of IL - 10 increased dramatically compared with normal values （all P〈0.05）. After CBP, the serum levels of TNF- α, IL- 6 and IL- 8 all dropped to certain extent and became lower than those before the treatment （all P〈0.05）. IL - 10＇s serum level was not changed compared with that before treatment. Those who received CBP stayed in the ICU for a longer period compared with control group, and the ICU expenses increased evidently with significant differences （P〈0.05 or P〈0.01）. However, there was no difference in mortality between the two groups. Conclusion Under the effect of immunosuppressant in the post-OLT period, the excessive release of the anti inflammatory mediators may become dominant leading to imbalance between proinflammatory and anti-inflammatory mediators leading to MODS. CBP may remove serum proinflammatory cytokines to act as an effective supportive treatment.

关 键 词：肝移植 多器官功能障碍综合征 围手术期 细胞因子 

分 类 号：R686[医药卫生—骨科学]