血浆置换对肝功能衰竭患者血清细胞因子的影响

Influence of Plasma Exchange on Serum Cytokines in Liver Failure Patients

目的探讨血浆置换治疗对肝功能衰竭患者血清细胞因子人单核细胞趋化蛋白-1(MCP-1)和表皮生长因子(EGF)水平的影响。方法应用血浆置换治疗46例肝功能衰竭患者,观察患者治疗前后血生化指标的变化及血清MCP-1和EGF的变化。结果治疗后有效22例(47.8%),无效24例;治疗后患者血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、凝血酶原时间(PT)及血氨(NH3)水平均较治疗前显著降低,差异有统计学意义(P<0.01)。治疗后患者血清MCP-1水平较治疗前显著下降,差异有统计学意义(P<0.01);而血清EGF水平与治疗前比较差异无统计学意义(P>0.05)。治疗后有效者血清MCP-1水平较无效者显著降低,差异有统计学意义(P<0.05);而血清EGF水平在两者中差异无统计学意义(P>0.05)。结论血浆置换治疗能够显著降低肝功能衰竭患者血清促炎细胞因子MCP-1水平,且不减少肝脏保护性因子EGF水平,从而延缓患者病情进展,改善预后。

Objective To explore the changes of human monocyte chemoattractant protein-1（MCP-1） and epidermal growth factor（EGF） in liver failure patients after treatment of plasma exchange.Methods Forty six liver failure patients were treated by plasma exchange.The changes of serum biochemical indicators,MCP-1,EGF were determined before treatment and after.Results Effectiveness was noted in 22 patients（47.8%）,ineffectiveness in 24（52.2%） after treatment.The levels of serum total bilirubin（TBIL）,alanine aminotransferase（ALT）,ammonia（NH3） and prothrombin time（PT） decreased significantly after treatment as compared with those before treatment（P〈0.01）,MCP-1 decreased significantly（P〈0.01）,but there was not significant difference in serum EGF level between post-and pre-treatments（P〉0.05）.MCP-1 level was significantly lower in patients with posttreatment effectiveness than in those without（P〈0.05）,but no significant difference was noted in EGF level（P〉0.05）.Conclusion Treatment of plasma exchange can decrease significantly the pro-inflammatory cytokines MCP-1 without reducing liver protective factor EGF in liver failure patients,thus to delay disease progression and improve prognosis.