血浆置换联合血液滤过对肝衰竭患者炎症细胞因子的影响  

Effect of plasma exchange plus hemofiltration on inflammatory cytokines in patients with liver failure

作　　者：张雪华[1,2] 李明[1,2] 朱传武[1,2] 沈兴华[1,2] 朱晓燕[1,2] 

机构地区：[1]苏州市第五人民医院 [2]苏州大学附属传染病医院重症医学科,江苏省苏州市215007

出　　处：《世界华人消化杂志》2015年第2期281-285,共5页World Chinese Journal of Digestology

摘　　要：目的:通过观察血浆置换(plasma exchange PE)联合血液滤过(hemofiltration,HF)治疗肝衰竭患者临床生化指标以及炎症细胞因子的水平变化,探讨其在肝衰竭治疗中的作用机制及意义.方法:在37例肝衰竭患者中,采用PE联合HF治疗17例、单用PE治疗20例,分别在治疗前后检测临床生化指标以及炎症细胞因子肿瘤坏死因子(tumor necrosis factor,TNF)、白介素2受体(interleukin-2 receptor,IL-2R)、IL-6和IL-10的变化,并比较其在治疗前后的变化.结果:17例PE与HF联合治疗组患者治疗后临床及生化指标除白蛋白(albumin,ALB)外均明显改善,治疗后总胆红素(total bilirubi T-BIL)、尿素氮(urea nitrogen,BUN)、肌酐(creatinine,Cr)、血氨(blood ammonia,NH和C反应蛋白(C reactive protein,CRP)与单用PE对照组比较,差异有统计学意义;同时P E联合H F治疗组患者治疗后炎症细胞因子TNF、IL-2R、IL-6、IL-10均明显下降,也显著低于单用PE治疗组.此外,PE联合HF治疗组患者治疗后近期总有效率为82.4%,显著高于PE治疗组.结论:PE联合HF治疗肝衰竭患者可显著降低炎性细胞因子水平。AIM： To analyze the influence of plasma exchange（PE） combined with hemofiltration（HF） on the levels of serum inflammatory cytokines and biochemical parameters in patients with liver failure. METHODS： Seventeen patients were treated by PE plus HF and 20 patients were treated by PE alone. Serum levels of cytokines including tumor necrosis factor（TNF）, interleukin（IL）-2 receptor, IL-6, IL-10 and biochemical parameters were measured before and after treatment. The differences in the levels of serum cytokines and biochemical parameters were compared between the two groups.RESULTS： There were significant differences in biochemical parameters except albumin level between before and after treatment in the PE plus HF group（P 〈0.05 for all）. Total bilirubin（T-BIL）, blood urea nitrogen（BUN）, creatinine（CRE）, ammonia（NH3） and C reactive protein（CRP） after treatment differed significantly between the two groups（P 〈0.05 for all）. The levels of tumor necrosis factor（TNF）, IL-2R,IL-6 and IL-10 after treatment were significantly lower than those before treatment in the PE plus HF group（P 〈0.05 all）, and these parameters in the combination group after treatment were significantly lower than those in the PE group（all P 〈0.05）. Total effective rate was 82.4% in the PE plus HF group, significantly higher than that in the PE group（P〈 0.05）. CONCLUSION ： The results suggest that serum levels of inflammatory cytokines can be significantly reduced by PE plus HF therapy,and the curative effect of PE plus HF is more remarkable than PE alone in patients with liver failure.

关 键 词：肝衰竭 血浆置换 血液滤过 炎症细胞因子 治疗 

分 类 号：R575.3[医药卫生—消化系统]