人工肝血浆置换联合分子吸附系统对重症肝炎肝硬化患者血清内毒素、细胞因子清除和肝功能的影响  

Effects of Artificial Liver Plasma Exchange Combined with Molecular Adsorbent Recirculating System on Serum Endotoxin,Cytokine Clearance and Liver Function in Patients with Severe Hepatitis and Cirrhosis

作　　者：张文凤[1] ZHANG Wen- feng(Department of Internal Medicine, Xichang People＇ s Hospital, Xichang 615000, China)

机构地区：[1]西昌市人民医院内二科,四川西昌615000

出　　处：《标记免疫分析与临床》2018年第6期863-866,917,共5页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨人工肝血浆置换(PE)联合分子吸附系统(MARS)对重症肝炎肝硬化患者血清内毒素、细胞因子清除和肝功能的影响。方法将我院105例重症肝炎肝硬化患者随机分为实验组(53例)和对照组(52例),实验组接受人工肝PE+MARS治疗,对照组接受MARS治疗,两组均治疗6个月,比较两组治疗前后血清内毒素、细胞因子清除和肝功能等情况。结果治疗6个月后,两组血清内毒素、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、凝血酶原时间(PT)均显著降低(P<0.05),凝血酶原活动度(PTA)、纤维蛋白原(FIB)及白陶土部分凝血酶时间(KPTT)均明显上升(P<0.05),实验组肝功能、凝血功能、内毒素和细胞因子水平改善幅度均大于对照组(P<0.05);实验组患者治疗1、3、6个月后临床症状改善情况均明显优于对照组(P<0.05);实验组存活率显著高于对照组(98.11%与86.54%,P<0.05);实验组发热发生率明显高于对照组(P<0.05),但皮疹、水肿、口唇麻木发生率与对照组比较差异无统计学意义(P>0.05)。结论 PE联合MARS能显著改善重症肝炎肝硬化患者临床症状和肝功能,降低内毒素水平,清除细胞因子,最终提高患者存活率。Objective To investigate the effects of artificial liver plasma exchange （PE） combined with molecular adsorbent recirculating system （MARS） on serum endotoxin, cytokine clearance and liver function in patients with severe hepatitis and cirrhosis. Methods A total of 105 patients with severe hepatitis and cirrhosis were randomly divided into experimental group （53 cases） and control group （52 cases ）. The combined group were treated with artificial liver PE combined with MARS, while the control group were treated with MARS alone. The two groups were treated for 6 months, and the serum endotoxin, cytokine clearance and liver function were compared between the two groups before and after treatment. Results After 6 months of treatment, serum endotoxin, interleukin - 8 （ IL- 8 ）, interleukin - 6 （ IL- 6 ）, tumor necrosis factor α （ TNF- α）, alanine aminotransferase （ ALT）, aspartate aminotransferase （ AST）, total bilirubin （TBIL） and prothrombin time （PT） were significantly downregulated （ P 〈 0.05 ）, while prothrombin activity （ PTA）, fibrinogen （FIB） and kaolin partial thromboplastin time （KPTT） were significantly upregulated in two groups （ P 〈 0.05 ）. The improvement of liver function, coagulation function, endotoxin or cytokine levels in the experimental group was greater than that in the control group （ P 〈 0. 05 ）. The relieve of clinical symptoms in the experimental group after 1 month, 3 months or 6 mouths of treatment was obviously better than that in the control group （ P 〈 0.05 ）. The survival rate of the experimental group was significantly higher than that of the control group （98.11% vs 86.54% ） （P 〈0.05）. The incidence of fever in the experimental group was higher than that in the control group （ P 〈 0.05 ）, but there was no significant difference between the two groups in the incidence rates of skin rash, edema and lip numbness （ P 〉 0.05 ）. Conclusion PE combined with MARS can significantly relieve

关 键 词：血浆置换 分子吸附系统 重症肝炎 肝硬化 

分 类 号：R473.6[医药卫生—护理学]