以血浆作透析液行血液透析联合高容量血液滤过治疗对肝衰竭患者血浆细胞因子的影响

Effect of hemodialysis with plasma-based dialysate plus high volume hemofiltration on plasma cytokines in patients with liver failure

目的以人体新鲜冰冻血浆作透析液行血液透析(HD-PBD)后继续进行高容量血液滤过(HVHF),观察其对肝功能衰竭患者血浆细胞因子的影响。方法12例肝功能衰竭患者行HD-PBD治疗6h后,应用同一滤器(AV600)继续行HVHF治疗24h。分别在治疗前(0 h)及治疗后6、30 h取血,应用酶联免疫吸附法(ELISA)检测TNF-α、IL-1β、IL-6和IL-8的水平,同时观察治疗前后血清胆红素、总胆汁酸(TBA)、血氨、BUN、Scr水平,并监测动脉血气分析和电解质浓度的变化。结果(1)HD-PBD对胆红素和TBA的清除较HVHF明显(P＜0．05)；(2) HVHF在清除血氨、BUN、Scr、纠正电解质和酸碱失衡方面比HD-PBD更有效(P＜0．05)；(3)停止HD-PBD后继续行HVHF治疗24 h,胆红素仍有所下降(P＜0．05)；(4)治疗后TNF-α、IL-6和IL-8较治疗前明显下降。结论对肝功能衰竭患者,HD-PBD联合HVHF治疗能显著降低血清胆红素、总胆汁酸、BUN、Scr、血氨及部分细胞因子,调节水电解质和酸碱平衡,并且安全、简便、易行和成本低廉。

Objective To propose a new blood purification modality-hemodialysis with plasmabased dialysate （HD-PBD） plus high volume hemof＇dtration （HVHF） for patients with liver failure, and to evaluate the effect of this treatment on plasma cytokines. Methods Twelve patients with liver failure were included in this study. All patients received HD-PBD therapy in the first 6 hours, and then were treated with HVHF for 24 hours with the same filter （AV600）. The levels of TNF-α, IL-1β, IL-6 and IL-8 in plasma before and after HD-PBD plus HVHF for 6 and 24 hours were examined respectively by ELISA, and changes of clinical parameters were observed at the same time point. Serum bilirubin, total bile acids （TBA）, serum ammonia, blood urea nitrogen （BUN） and serum creatinine （Scr） were detected before and after treatment. Arterial blood gas analysis and the concentration of electrolytes were monitored before and after treatment. Results （1）HD-PBD for 6 hours was more effective than HVHF for 24 hours in removal of serum bilirubin and TBA（P〈 0.05）. （2）Serum ammonia, BUN, Scr, arterial blood HCO3^-,PCO2,PO2 and electrolytes did not show significant difference before and after HD-PBD （P 〉 0.05）, but these parameters significantly changed before and after HVHF （P 〈 0.05）. （3）The average level of serum bilirubin was sharply decreased after HVHF for 24 h following HD-PBD（P〈 0.05）. （4）Mter HD-PBD plus HVHF, there was a marked reduction of the plasma levels of TNF-α, IL-6 and IL-8. Conclusions HD-PBD plus HVHF, a newly proposed modality for patients with liver failure, can effectively decrease serum bilirubin, TBA, BUN, Scr, ammonia and cytokines, and adjust water-electrolyte as well as acidalkali balance. It is a low-cost, safe, simple and convenient therapy.