摘要
目的探讨肝衰竭患者人工肝治疗(血浆置换)术前与术后72 h细胞因子变化与预后的关系。方法选择2011年4月至2012年4月在兰州市第二人民医院感染科住院并经血浆置换治疗的58例肝衰竭患者,根据临床转归情况,分为好转组和未愈组。测定治疗前及术后72 h血清中白细胞介素(IL)-4、IL-6、IL-10、肿瘤坏死因子(TNF)α以及干扰素(IFN)γ的水平,观察其变化和预后的关系。数据以均数±标准差(x±s)表示,治疗前后比较采用配对t检验,组间比较采用组间t检验。结果经血浆置换治疗后,患者好转率为67.24%(39/58),未愈率为32.75%(19/58)。好转组血浆置换治疗术前和术后72h血清IL-4、IL-6、IL-10、TNFα以及IFNγ差异有统计学意义(t=2.048～5.163,P<0.05),其中IL-4、IL-6、TNFα、IFNγ的下降程度较未愈组患者更为明显,IL-10水平提升程度较未愈组明显。术前IL-6、TNFα水平未愈组较好转组明显偏高,差异有统计学意义(t=2.024～2.174,P<0.05)。结论血浆置换能有效清除血清中炎性细胞因子TNFα、IL-4、IL-6、IFNγ,提升IL-10水平,是治疗肝衰竭的有效措施。肝衰竭患者发生的免疫损伤过程中,IL-6、TNFα较其他细胞因子似乎起着更为重要的作用。
Objective To investigate the relationship between changes in serum cytokine levels at 72 h after artificial liver therapy （ plasma exchange, PE） and clinical prognosis in patients with liver failure. Methods Fifty - eight patients with liver failure, who received PE in Department of Infectious Diseases, The No. 2 People＇s Hospital of Lanzhou from April 2011 to April 2012, were included in the investiga- tion; they were divided into improved group and uncured group according to theil^treatment outcomes. The serum interleukin （IL） -4, IL - 6, IL - 10, tumor necrosis factor （TNF）ct, and interferon （IFN）＂,/levels before＂and 72 h after therapy were measured, and the relationship between the changes in these indices and prognosis was observed. The data were expressed in the form of mean ＋ standard deviation. The baseline values and values after therapy were compared by paired t - test, and the differences between two groups were determined by the t - test for comparison between groups. Results After PE therapy, 67.24% of all patients （39/58） showed an improvement, while 32.75% （19/58） were not cured. At 72 h after therapy, the improved group had significant changes in serum IL -4, IL -6, IL - 10, TNFa, and IFN/levels （t =2 048 -5. 163, P 〈0.05）, and had more decrease in serum IL -4, IL -6, TNFa, and IFNy and more increase in serum IL- 10 level compared with the uncured group. Before therapy, the serum IL- 6 and TNFa levels were significantly higher in the uncured group than in the improved group （ t = 2. 024 - 2. 174, P 〈 0. 05 ）. Conclusion Artificial liver therapy can decrease TNFa, IL - 4, IL - 6, and IFNyand increase IL - 10 in serum and thus is an effective treatment for liver failure. It seems that IL - 6 and TNFct play a more im- portant role than other cytokines in immune injury in patients with liver failure.
出处
《临床肝胆病杂志》
CAS
2013年第7期535-537,共3页
Journal of Clinical Hepatology
