临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2015年
4期
578-581
,共4页
肝功能衰竭%血浆置换%细胞因子类
肝功能衰竭%血漿置換%細胞因子類
간공능쇠갈%혈장치환%세포인자류
liver failure%plasma exchange%cytokines
目的：观察人工肝血浆置换术治疗对肝衰竭患者血清白细胞介素（IL）6、肿瘤坏死因子（TNF）α及干扰素（IFN）γ的清除效果，进一步探讨人工肝支持系统在肝衰竭治疗中的意义。方法收集2012年2月至2013年2月在蚌埠医学院第一附属医院住院的36例肝衰竭患者，分别在血浆置换术前及多次治疗后的次日清晨采集血标本。用ELISA法测定血浆TNFα、IL－6、IFNγ的含量，计量资料治疗前后组间比较采用t检验，多组间比较采用方差分析，进一步两两比较采用SNK－q检验。结果36例肝衰竭患者TNFα、IL－6、IFNγ治疗前分别为（381．23±190．57）ng／L、（77．9±83．09）ng／L、（534．65±471．19）ng／L，治疗后分别为（274．12±212.30）ng／L、（54．8±63．32）ng／L、（259．65±312．26）ng／L，治疗前后比较，差异均有统计学意义（P值均＜0．05）。亚急性肝衰竭和慢加急性（亚急性）肝衰竭患者根据临床表现的严重程度又分为早期、中期和晚期。结果发现，IL－6、TNFα在早、中、晚期组比较差异均有统计学意义（P值均＜0．05）；IFNγ早、中、晚期组差异有统计学意义（P＜0．05）；进一步两两比较IFNγ早期组与晚期组、中期组与晚期组相比，差异均有统计学意义（P值均＜0．05）。经过人工肝血浆置换治疗，其中有29例肝衰竭患者好转痊愈，余7例恶化，TNFα、IL－6、IFNγ在好转痊愈组降低程度分别为（122．58±57．64）ng／L、（26．93±7．25）ng／L、（284．06±94．31）ng／L，均显著高于恶化组下降水平（P值均＜0．05）。急性肝衰竭有效率为66．67％，亚急性肝衰竭有效率为85．71％，慢加急性（亚急性）肝衰竭有效率为86.36％，慢性肝衰竭有效率为50．00％。结论连续的人工肝血浆置换术治疗，能有效清除肝衰竭患者血浆促炎性细胞因子水平，改善患者临床症状。
目的：觀察人工肝血漿置換術治療對肝衰竭患者血清白細胞介素（IL）6、腫瘤壞死因子（TNF）α及榦擾素（IFN）γ的清除效果，進一步探討人工肝支持繫統在肝衰竭治療中的意義。方法收集2012年2月至2013年2月在蚌埠醫學院第一附屬醫院住院的36例肝衰竭患者，分彆在血漿置換術前及多次治療後的次日清晨採集血標本。用ELISA法測定血漿TNFα、IL－6、IFNγ的含量，計量資料治療前後組間比較採用t檢驗，多組間比較採用方差分析，進一步兩兩比較採用SNK－q檢驗。結果36例肝衰竭患者TNFα、IL－6、IFNγ治療前分彆為（381．23±190．57）ng／L、（77．9±83．09）ng／L、（534．65±471．19）ng／L，治療後分彆為（274．12±212.30）ng／L、（54．8±63．32）ng／L、（259．65±312．26）ng／L，治療前後比較，差異均有統計學意義（P值均＜0．05）。亞急性肝衰竭和慢加急性（亞急性）肝衰竭患者根據臨床錶現的嚴重程度又分為早期、中期和晚期。結果髮現，IL－6、TNFα在早、中、晚期組比較差異均有統計學意義（P值均＜0．05）；IFNγ早、中、晚期組差異有統計學意義（P＜0．05）；進一步兩兩比較IFNγ早期組與晚期組、中期組與晚期組相比，差異均有統計學意義（P值均＜0．05）。經過人工肝血漿置換治療，其中有29例肝衰竭患者好轉痊愈，餘7例噁化，TNFα、IL－6、IFNγ在好轉痊愈組降低程度分彆為（122．58±57．64）ng／L、（26．93±7．25）ng／L、（284．06±94．31）ng／L，均顯著高于噁化組下降水平（P值均＜0．05）。急性肝衰竭有效率為66．67％，亞急性肝衰竭有效率為85．71％，慢加急性（亞急性）肝衰竭有效率為86.36％，慢性肝衰竭有效率為50．00％。結論連續的人工肝血漿置換術治療，能有效清除肝衰竭患者血漿促炎性細胞因子水平，改善患者臨床癥狀。
목적：관찰인공간혈장치환술치료대간쇠갈환자혈청백세포개소（IL）6、종류배사인자（TNF）α급간우소（IFN）γ적청제효과，진일보탐토인공간지지계통재간쇠갈치료중적의의。방법수집2012년2월지2013년2월재방부의학원제일부속의원주원적36례간쇠갈환자，분별재혈장치환술전급다차치료후적차일청신채집혈표본。용ELISA법측정혈장TNFα、IL－6、IFNγ적함량，계량자료치료전후조간비교채용t검험，다조간비교채용방차분석，진일보량량비교채용SNK－q검험。결과36례간쇠갈환자TNFα、IL－6、IFNγ치료전분별위（381．23±190．57）ng／L、（77．9±83．09）ng／L、（534．65±471．19）ng／L，치료후분별위（274．12±212.30）ng／L、（54．8±63．32）ng／L、（259．65±312．26）ng／L，치료전후비교，차이균유통계학의의（P치균＜0．05）。아급성간쇠갈화만가급성（아급성）간쇠갈환자근거림상표현적엄중정도우분위조기、중기화만기。결과발현，IL－6、TNFα재조、중、만기조비교차이균유통계학의의（P치균＜0．05）；IFNγ조、중、만기조차이유통계학의의（P＜0．05）；진일보량량비교IFNγ조기조여만기조、중기조여만기조상비，차이균유통계학의의（P치균＜0．05）。경과인공간혈장치환치료，기중유29례간쇠갈환자호전전유，여7례악화，TNFα、IL－6、IFNγ재호전전유조강저정도분별위（122．58±57．64）ng／L、（26．93±7．25）ng／L、（284．06±94．31）ng／L，균현저고우악화조하강수평（P치균＜0．05）。급성간쇠갈유효솔위66．67％，아급성간쇠갈유효솔위85．71％，만가급성（아급성）간쇠갈유효솔위86.36％，만성간쇠갈유효솔위50．00％。결론련속적인공간혈장치환술치료，능유효청제간쇠갈환자혈장촉염성세포인자수평，개선환자림상증상。
Objective To observe the effect of plasma exchange (PE)therapy for removing serum interleukin-6 (IL-6),tumor necrosis factor alpha (TNFα),and interferon gamma (IFNγ)in patients with liver failure,and to assess the value of artificial liver support system in the treatment of liver failure.Methods The study included 36 patients with liver failure who were hospitalized in the First Affiliated Hospi-tal of Bengbu Medical College from February 2012 to February 2013.Blood samples were collected before PE and the next morning after mul-tiple treatments.Plasma TNFα,IL-6,and IFNγlevels were measured by ELISA.Between-group comparison of measurement data before and after treatment was made by independent-samples t test,and comparison of mean values between groups was made by analysis of vari-ance.Results All the 36 liver failure patients had significantly lower levels of TNFα(381.23 ±190.57 ng/L vs 274.12 ±212.30 ng/L,P<0.05),IL-6 (77.9 ±83.09 ng/L vs 54.8 ±63.32 ng/L,P<0.05),and IFNγ(534.65 ±471.19 ng/L vs 259.65 ±312.26 ng/L,P<0.05)after treatment than before treatment.According to the severity of clinical manifestations,the patients with subacute or acute-on-chronic (subacute)liver failure were divided into early stage,middle stage,and advanced stage groups.There were significant differ-ences in IL-6 and TNFαdecreases between the early stage,middle stage,and advanced stage groups (P<0.05).IFNγdecrease signifi-cantly differed between the early stage or middle stage group and advanced stage group (P<0.05),but not between the former two groups (P>0.05).After PE therapy,29 out of 36 liver failure patients recovered well,while the remaining 7 patients deteriorated.The recovered group had significantly greater decreases in TNFα(122.58 ±57.64 ng/L vs 42.45 ±19.86 ng/L,P<0.05),IL-6 (26.93 ±7.25 ng/L vs 6.71 ±3.55 ng/L,P<0.05),and IFNγ(284.06 ±94.31 ng/L vs 217.47 ±45.76 ng/L,P<0.05)than the deteriorated group.The response rates of patients with acute,subacute,acute -on -chronic,and chronic liver failure were 66.67%,85.71%,86.36%,and 50%,respectively.Conclusion Continuous artificial liver PE therapy can effectively remove pro-inflammatory cytokines from plasma and thus improve the clinical outcomes of patients with liver failure.
