人工肝支持系统对慢性重型肝炎患者血清细胞因子影响的动态研究

目的 研究人工肝支持系统(ALSS)治疗慢性重型肝炎前后血清肿瘤坏死因子α(TNF α)、转化生长因子β_1(TGF β_1)及内毒素、一氧化氮水平动态变化,探讨其与重型肝炎的发生及预后的关系,进一步阐明ALSS在重型肝炎治疗中的意义。 方法 42例慢性重型肝炎患者,分别在ALSS治疗前后用ELISA法测定血清TNFα、TGF β_1水平,用基质偶氮显色法和Griess法分别测定血清内毒素及一氧化氮水平,比较它们在ALSS治疗前后的变化,并分析其与病情及预后的相关性。 结果 42例患者ALSS治疗前血清中TNFα(481.57±229.31)pg/ml,TGFβ_1(44.09±31.73)ng/ml,内毒素(1.05±0.37)Eu/ml,一氧化氮(71.15±33.09)μmol/L,其中内毒素与TNF α含量及血清总胆红素水平有相关性。ALSS治疗后以上指标均有明显下降,TNFα(156.46±78.12)pg/ml,P<0.05;TGFβ_1(27.77±23.28)ng/ml,P<0.01,内毒素(0.28±0.22)Eu/ml,P<0.001;一氧化氮(58.11±29.30)μmol/L,P<0.001;其中血清一氧化氮与凝血酶原时间及血氨浓度也具相关性。 结论 重型肝炎肝细胞损害机制中,内毒素血症和血清一氧化氮浓度可能是重要的两个因素。人工肝支持系统治疗慢性重型肝炎后,血清内毒素及TNFα等细胞因子水平明显下降,有助于改善患者预后。

The effect of artificial support system on serum cytokine in chronic severe hepatitis

OBJECTIVE: To explore the changes of cytokines including TNFalpha, TGFbeta1 and nitrogen monoxide, and endotoxin in the serum of chronic severe hepatitis after the treatment of ALSS, and to evaluate further the value of ALSS in the treatment of chronic severe hepatitis. METHODS: Forty two patients were screened. The changes of TNFalpha, TGFbeta1, nitrogen monoxide and endotoxin were detected respectively. The relationship between the cytokines and the severity and prognosis were further analyzed. RESULTS: ALSS was effective to decrease the serum concentration of cytokines. TNFalpha dropped from (481.57+/-229.33) pg/ml to (156.46+/-78.12) pg/ml (P < 0.05). TGFbeta1 from (44.09+/-31.73) ng/ml to (27.77+/-23.28) ng/ml (P < 0.01), endotoxin from (1.05+/-0.37) Eu/ml to (0.28+/-0.22) Eu/ml (P < 0.001). NO from (71.15+/-33.09) micromol/L to (58.11+/-29.30) micromol/L (P < 0.001). Before the therapy endotoxin was related with TNFalpha and total bilirubin, while after the therapy, NO was related with protime and aminonemia. CONCLUSION: High level of endotoxin and nitrogen monoxide in serum plays an important role in hepatocyte damage of chronic severe hepatitis. The changes of serum endotoxin TNFalpha, TGFbeta1 and nitrogen monoxide level in patients with chronic severe hepatitis can be used to judge the severity and prognosis of severe hepatitis. ALSS is a reliable hepatic support device for chronic severe hepatitis