血浆置换对重型肝炎细胞因子的影响  

Effects of plasma exchange on cytokine in severe hepatitis

作　　者：张勇[1] 曾维政[1] 蒋明德[1] 徐辉[1] 熊碧君[1] 郑淑梅[1] 吴晓玲[1] 

机构地区：[1]解放军成都军区总医院消化内科,四川成都610083

出　　处：《西部医学》2007年第6期1040-1042,共3页Medical Journal of West China

摘　　要：目的研究血浆置换治疗重型肝炎前后血清内毒素(LPS)、肿瘤坏死因子-α(TNF-α)、白细胞介素-18(IL-18)、一氧化氮(NO)的变化,探讨人工肝治疗重型肝炎的机制以及细胞因子在重型肝炎发生及预后的关系。方法58例慢性重型肝炎患者给予血浆置换108次。检测人工肝治疗前后及病情好转或加重时血清LPS、TNF-α、IL-18、NO水平。结果重型患者经血浆置换治疗后近期治愈好转率为60.3%(35/58);早、中、晚期重型肝炎治愈好转率分别为93.3%(13/15)、63%(17/27)、25%(4/16)。血浆置换后血清LPS、TNF-α、IL-18、NO降低;血浆置换治疗前及治疗后血清中细胞因子各期间比较,早期<中期<晚期,差异显著。有效组病情好转时血清中LPS、TNF-α、IL-18、NO水平较入院时下降,而无效组患者在病情加重时血清中LPS、TNF-α、IL-18、NO水平较入院时无变化。结论血浆置换能有效降低血清中LPS、TNF-α、IL-18、NO水平,从而减轻炎症反应对肝细胞的继发性损伤.动态观察这些细胞因子水平对了解病情、判断预后、改进治疗策略有指导意义。Objecitve To explore the level changes of cytokines including endotoxin, INP-α, IL-18, nitrogen monoxide （NO） in the serum of patients with severe hepatitis after plasma exchange, and to evaluate artifacial liver therapy in the treatment of severe hepatitis. Methods 58 patients with severe hepatitis were treated with 108 times of plasma exchange. The concentrations of the serum endotoxin, TNF-α, IL-18, nitrogen monoxide before and after the treatment and after aggravation or improvement were determined. Results After plasma exchange, the improvement or cure rate of serve hepatitis was 60. 3%（35/58）,and the improvement or cure rates of serve hepatitis in early stage , middle stage and late stage were 93.3%（14/15）, 63%（17/27）and 25%（4/16）, respectively. After plasma exchange, the levels of serum LPS, TNF-α, IL-18 and NO decreased significantly（P〈0.01 or P〈0.05） . Before and after plasma exchange, the differences of the levels of serum LPS, TNF-α,IL-18 and NO at early stage, middle stage and late stage severe hepatitis were significant （late stage〉middle stag〉 late stage. P〈0.01 or P〈0.05）. The levels of the cytokines when patients＇ condition was improved were lower than those in admission in effective groups （P〈 0.01）. There was no difference in the levels of the cytokines in aggravation compare with those in admission in ineffective groups（P〈0.05）. Conclusion Plasma exchange can significantly decrease the levels of serum LPS, TNF-α, IL-18 and NO, and alleviate the iniury to hepatocytes from inflammatory reaction. Persistent determination of the cellular factors can provide the guidance to the treatment for this disease and improve the prognosis and treatment strategy.

关 键 词：重型肝炎 人工肝 血浆置换 内毒素 肿瘤坏死因子Α 白细胞介素-18 一氧化氮 

分 类 号：R575.1[医药卫生—消化系统]