人工肝支持系统对肝移植围手术期肝衰竭患者Gc球蛋白的影响

Effects of non-bioartificial liver support system on Gc-giobulin in patients with liver failure

目的研究人工肝支持系统（血浆置换联合连续性静脉静脉血液透析滤过）对肝衰竭患者血清Gc球蛋白的影响，探讨血清Gc球蛋白在肝衰竭患者病情预后评估中的意义。方法将81例肝衰竭患者按治疗方案不同分为人工肝治疗组（43例），常规治疗组（38例）；然后再分为人工肝治疗有效组（A组）、人工肝治疗无效组（B组）、常规治疗有效组（C组）和常规治疗无效组（D组），比较各组间治疗前后及治疗过程中Gc球蛋白的变化，分析Gc球蛋白分别和白细胞介素（IL）-18、IL-10、IL-4、肿瘤坏死因子α、内毒素、一氧化氮合酶、可溶性血管细胞黏附分子1、可溶性细胞间黏附分子1之间的关系。根据资料不同分别采用微验、单因素方差分析（oneway ANOVA）、Pearson相关分析或x^2检验。结果（1）人工肝治疗组好转率为67．44％（29／43），常规治疗组治疗好转率为34．21％（13／38，P〈0．01）。（2）人工肝治疗组治疗后Gc球蛋白显著升高，治疗前后比较，差异有统计学意义（P〈0．01）；治疗后与常规治疗组治疗后比较，差异有统计学意义（P〈0．01），其中A组和C组治疗后明显升高，但A组治疗后较C组治疗后升高明显，两组间差异有统计学意义（P〈0．01）；与B组和D组治疗后比较，差异有统计学意义（P〈0．01）；各组肝衰竭患者血清Gc球蛋白水平的动态观察结果显示：A组和C组患者血清Gc球蛋白水平呈现由低到高的变化趋势；B组和D组患者的血清Gc球蛋白水平波动，但无显著升高（P〉0．05）。（3）Gc球蛋白和IL-4、IL—18和肿瘤坏死因子α、一氧化氮合酶、可溶性血管细胞黏附分子1、可溶性细胞间黏附分子1成负相关关系，而与IL-10之间无相关性。结论人工肝支持系统能提高肝衰竭患者血清Gc球蛋白的水平，并最终可提高肝衰竭抢救成功率，改善预后。Gc球蛋白水平可作为临床转归的预测指标。

Objective To investigate the effects of artificial liver support system（plasma exchange combined with continuous veno - venous hemodiafiltration, PE ＋ CVVHDF） on Gc globulin in patients with liver failure. Methods 81 patients with liver failure were divided into 4 groups according to the treatment protocols and indicators such as liver function and clinical symptoms. Totally 29 effective cases and 14 ineffective cases in the ALSS group versus 15 effective cases and 23 ineffective cases in the medical group were included. Finally the changes of Gc globulin were observed in four subgroups before and after treatment. The correlation between Gc globulin and IL-10, IL-4, IL-18, TNF α endotoxin, NO, sVCAM-land sICAM- I were analyzed by Pearson correlation analysis. Results The effectiveness rate was 67.44% in ALSS group and 34.21% in the medical treatment （P 〈 0.01 ）. Gc globulin, one of liver cell protection proteins was notably increased following the artificial liver treatment as compared with the increase in the medical treatment （P 〈0.01 ）. The time-response curve of Gc globulin level had a significant upward trend in the effective group as compared to no significant rise in the ineffective group. Moreover, the Gc globulin was negatively correlated with IL-4, IL-18, TNF-α, SVCAM-1, SICAM-1 and NO. In contrat, no correlation existed between Gc globulin and IL- 10. Conclusion The treatment with artificial liver can improve the outcome of the patients with liver failure. The level of Gc globulin was correlated with the curative effect and thus may be used as a potential indicator for curative effect forcast in the patients with liver failure.