CAJ | 학술논문

目的研究人工肝支持系统(血浆置换联合连续性静脉-静脉血液透析滤过)对肝衰竭患者血清Gc球蛋白的影响,探讨血清Gc球蛋白在肝衰竭患者病情预后评估中的意义.方法将81例肝衰竭患者按治疗方案不同分为人工肝治疗组(43例),常规治疗组(38例);然后再分为人工肝治疗有效组(A组)、人工肝治疗无效组(B组)、常规治疗有效组(C组)和常规治疗无效组(D组),比较各组间治疗前后及治疗过程中Gc球蛋白的变化,分析Gc球蛋白分别和白细胞介素(IL)-18、IL-10、IL-4、肿瘤坏死因子α、内毒素、一氧化氮合酶、可溶性血管细胞黏附分子1、可溶性细胞间黏附分子1之间的关系.根据资料不同分别采用t检验、单因素方差分析(one-way ANOVA)、Pearson相关分析或x2检验.结果 (1)人工肝治疗组好转率为67.44%(29/43),常规治疗组治疗好转率为34.21%(13/38,P＜0.01).(2)人工肝治疗组治疗后Gc球蛋白显著升高,治疗前后比较,差异有统计学意义(P＜0.01);治疗后与常规治疗组治疗后比较,差异有统计学意义(P＜0.01),其中A组和C组治疗后明显升高,但A组治疗后较C组治疗后升高明显,两组间差异有统计学意义(P＜0.01);与B组和D组治疗后比较,差异有统计学意义(P＜0.01);各组肝衰竭患者血清Gc球蛋白水平的动态观察结果显示:A组和C组患者血清Gc球蛋白水平呈现由低到高的变化趋势;B组和D组患者的血清GC球蛋白水平波动,但无显著升高(P＞0.05).(3)Gc球蛋白和IL-4、IL-18和肿瘤坏死因子α、一氧化氮合酶、可溶性血管细胞黏附分子1、可溶性细胞间黏附分子1成负相关关系,而与IL-10之间无相关性.结论人工肝支持系统能提高肝衰竭患者血清Gc球蛋白的水平,并最终可提高肝衰竭抢救成功率,改善预后.Gc球蛋白水平可作为临床转归的预测指标.
목적 연구인공간지지계통(혈장치환연합련속성정맥-정맥혈액투석려과)대간쇠갈환자혈청Gc구단백적영향,탐토혈청Gc구단백재간쇠갈환자병정예후평고중적의의.방법 장81례간쇠갈환자안치료방안불동분위인공간치료조(43례),상규치료조(38례);연후재분위인공간치료유효조(A조)、인공간치료무효조(B조)、상규치료유효조(C조)화상규치료무효조(D조),비교각조간치료전후급치료과정중Gc구단백적변화,분석Gc구단백분별화백세포개소(IL)-18、IL-10、IL-4、종류배사인자α、내독소、일양화담합매、가용성혈관세포점부분자1、가용성세포간점부분자1지간적관계.근거자료불동분별채용t검험、단인소방차분석(one-way ANOVA)、Pearson상관분석혹x2검험.결과 (1)인공간치료조호전솔위67.44%(29/43),상규치료조치료호전솔위34.21%(13/38,P＜0.01).(2)인공간치료조치료후Gc구단백현저승고,치료전후비교,차이유통계학의의(P＜0.01);치료후여상규치료조치료후비교,차이유통계학의의(P＜0.01),기중A조화C조치료후명현승고,단A조치료후교C조치료후승고명현,량조간차이유통계학의의(P＜0.01);여B조화D조치료후비교,차이유통계학의의(P＜0.01);각조간쇠갈환자혈청Gc구단백수평적동태관찰결과현시:A조화C조환자혈청Gc구단백수평정현유저도고적변화추세;B조화D조환자적혈청GC구단백수평파동,단무현저승고(P＞0.05).(3)Gc구단백화IL-4、IL-18화종류배사인자α、일양화담합매、가용성혈관세포점부분자1、가용성세포간점부분자1성부상관관계,이여IL-10지간무상관성.결론 인공간지지계통능제고간쇠갈환자혈청Gc구단백적수평,병최종가제고간쇠갈창구성공솔,개선예후.Gc구단백수평가작위림상전귀적예측지표.
Objective To investigate the effects of artificial liver support system(plasma exchange combined with continuous veno - venous hemodiafiltration, PE + CVVHDF) on Gc globulin in patients with liver failure. Methods 81 patients with liver failure were divided into 4 groups according to the treatment protocols and indicators such as liver function and clinical symptoms. Totally 29 effective cases and 14 ineffective cases in the ALSS group versus 15 effective cases and 23 ineffective cases in the medical group were included. Finally the changes of Gc globulin were observed in four subgroups before and after treatment.The correlation between Gc globulin and IL-10, IL-4, IL-18, TNF c, endotoxin, NO, sVCAM-land sICAM-1 were analyzed by Pearson correlation analysis. Results The effectiveness rate was 67.44% in ALSS group and 34.21% in the medical treatment (P ＜ 0.01). Gc globulin, one of liver cell protection proteins was notably increased following the artificial liver treatment as compared with the increase in the medical treatment (P ＜0.01). The time-response curve of Gc globulin level had a significant upward trend in the effective group as compared to no significant rise in the ineffective group. Moreover, the Gc globulin was negatively correlated with IL-4, IL-18, TNFα, SVCAM-1, SICAM-1 and NO. In contrat, no correlation existed between Gc globulin and IL-10. Conclusion The treatment with artificial liver can improve the outcome of the patients with liver failure. The level of Gc globulin was correlated with the curative effect and thus may be used as a potential indicator for curative effect forcast in the patients with liver failure.