微生态制剂对重型肝炎患者血清细胞因子的影响

Changes of plasma cytokines in patients with severe hepatitis treated with a probiotic preparation

目的 研究微生态制剂对重型肝炎患者临床症状、血清生物化学指标和细胞因子的影响。方法 112例重型肝炎患者，随机分为治疗组58例和对照组54例，治疗组在内科综合治疗的基础上加用双歧杆菌、嗜酸乳杆菌、肠球菌三联活菌胶囊和乳果糖口服4周，对照组单用内科综合治疗。观察两组患者治疗前后的临床症状、肝功能改善情况，采用酶联免疫吸附法检测治疗前后肿瘤坏死因子（TNF）α、胞介素（IL）－２、－6、－10的水平。结果治疗组临床症状和肝功能改善均优于对照组，血清TNFα、IL－6水平治疗组分别为（109．4±14．7）pg／ml和（84．3±20．1）pg／ml，对照组分别为（128．7±18．8）pg／ml和（109．1±18．7）pg／ml，治疗组比对照组明显降低，t值分别为2．924、2．996，P值均〈0．01，差异有统计学意义。IL-2、-10治疗组分别为（59．8±12．2）pg／ml和（30．6±6．6）pg／ml，对照组分别为（47．1±6．7）pg／ml和（22．5±6．1）pg／ml，治疗组比对照组明显升高，t值分别为2．979、3．055，P值均〈O．01，差异有统计学意义。结论 微生态制剂能降低TNFα、IL-6含量，升高IL-10、-2水平，抑制炎性介质的产生和减轻免疫反应对肝细胞的损伤，从而改善临床症状和肝功能。

Objective To study the changes of plasma cytokines in patients with severe hepatitis treated with a probiotic preparation. Methods One hundred twelve patients with severe hepatitis treated with a basic regimen were randomly divided into a probiotic preparation treatment group and a control group. Their plasma cytokines such as tumor necrosis factor alpha, interleukin-2, interleukin-6, intedeukin-10, were determined by conventional techniques. Results Clinical symptoms of 84.5% of the treatment group were obviously improved. The treatment effectiveness in this group was better than that in the control group （ X^2 = 8.888, P 〈 0.01）. It showed that liver functions were significantly improved compared to those of the control group （P 〈 0.01）. After the probiotic preparation therapy, there were significant decreases in the concentrations of TNF α and IL-6. TNF α and IL-6 in the treatment group and in the control group were （109.4 ± 14.7） pg/ml vs （128.7 ± 18.8） pg/ml and （84.3 ± 20.1） pg/ml vs （109.1± 18.7） pg/ml respectively （P 〈 0.01）. However, the concentrations of IL-10 and IL-2 in the treatment group increased obviously： IL-2 was （59.8 ± 12.2） pg/ml vs （47.1 ± 6.7） pg/ml and IL-10 was （30.6± 6.6） pg/ml vs （22.5 ± 6.1） pg/ml （P 〈 0.01）. Conclusion The probiotic preparation treatment effectively reduces the TNF α and IL-6 and increases the concentrations of IL-10 and IL-2 in the blood of the patients with severe hepatitis.