Effects of artificial liver plasma exchange on cytokines in patients with liver failure
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摘要:
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)...
Abstract: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 Hospital of Bengbu Medical College from February 2012 to February 2013. Blood samples were collected before PE and the next morning after multiple treatments. Plasma TNFα,IL- 6,and IFNγ levels 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 variance. 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 differences in IL- 6 and TNFα decreases between the early stage,middle stage,and advanced stage groups( P < 0. 05). IFNγ decrease significantly 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%,and50%,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.
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Key words:
- liver failure /
- plasma exchange /
- cytokines
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