还原型谷胱甘肽对急性胰腺炎肝损害的保护机制

Study on protective mechanism of reduced glutathione on patients with acute pancreatitis-associated liver injury

目的探讨还原型谷胱甘肽(GSH)对急性胰腺炎伴有肝损害的治疗机制。方法将急性胰腺炎肝损害患者随机分为常规治疗组(42例)及GSH治疗组(42例),分别于第1天和第8天检测两组治疗前后肝功能、TNF-α、IL-6、IL-1、血清丙二醛(malonaldehyde,MDA)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)、过氧化物岐化酶(superoxide dismutase,SOD)。结果 GSH对急性胰腺炎肝损害治疗效果优于常规治疗组(P<0.05)。治疗后血清TNF-α和IL-6水平,GSH治疗组[(2.34±0.15)ng.ml-1和(144.52±10.75)pg.ml-1]显著低于常规治疗组[(4.30±0.26)ng.ml-1和(244.82±15.16)pg.ml-1,P=0.001];血清IL-10水平,GSH治疗组[(71.57±3.07)pg.ml-1]显著高于常规治疗组[(65.98±3.17)pg.ml-1,P=0.002 4]。GSH治疗后血清TNF-α和IL-6水平显著低于治疗前[(4.41±0.25)ng.ml-1;(246.62±14.78)pg.ml-1,P=0.001];血清IL-10则较治疗前显著升高[(67.22±3.25)pg.ml-1,P=0.003 6];GSH治疗后血清MDA和SOD水平,GSH治疗后[(40.08±1.92)μmol.L-1和(19.75±1.23)KU.L-1]显著低于常规治疗后[(44.07±1.98)μmol.L-1;(24.52±1.21)KU.L-1,P=0.003和P=0.001],GSH治疗后血清GSH-Px[(48.13±1.85)μg.L-1]则较常规治疗后显著升高[(41.19±1.80)μg.L-1,P=0.001]。GSH治疗后血清MDA和SOD水平显著低于治疗前[(42.37±1.94)μmol.L-1和(24.14±1.31)KU.L-1,P=0.003和P=0.001],血清GSH-Px则较治疗前显著升高[(40.48±1.48)μg.L-1,P=0.001]。结论还原型谷胱甘肽对急性胰腺炎肝损害有较好的临床疗效,其机制可能与调节炎性介质和氧自由基作用有关。

Objective To study the protective mechanism of reduced glutathione on patients with acute pancreatitis-associated liver injury.Methods Eighty-four patients with liver injury and acute pancreatitis were randomly divided into two groups： routine treatment group（n=42） and GSH treatment group（n=42）.Liver function tests,TNF-α,IL-6,IL-10,malondialdehyde（MDA）,glutathione peroxidese（GSH-Px）and superoxide dismutase（SOD）were assessed on admission and on the 8th day.Results Compared with the routine treatment,GSH expressed better efficiency in the treatment of patients with acute pancreatitis-associated liver injury（P0.05）.The serum levels of TNF-α[（2.34±0.15）/ng·ml-1] and IL-6[（144.52±10.75）pg·ml-1] after GSH treatment were significantly lower than those in routine treatment group[（4.30±0.26）/ng·ml-1;（244.82±15.16）/pg·ml-1,（P=0.001）] respectively.While IL-10（71.57±3.07）pg·ml-1 in serum in GSH treatment group was significantly higher than that in routine treatment group[（65.98±3.17）pg·ml-1,（P=0.002 4）,the concentrations of TNF-α and IL-6 after GSH treatment were significantly lower than those in routine treatment group[（4.41±0.25）ng·ml-1;（246.62±14.78）pg·ml-1,（P=0.001）] respectively.The serum level of IL-10 after GSH treatmentwas significantly higher than that in routine treatment group（67.22±3.25）pg·ml-1,（P=0.003 6）.The serum MDA（40.08±1.92）μmol·L-1and SOD[（19.75±1.23）KU·L-1] levels after GSH treatment were significantly lower than those in routine treatment group（44.07±1.98）μmol·L-1;（24.52±1.21）KU·L-1,（P=0.003）和（P=0.001） respectively.However,the serum level of GSH-Px（48.13±1.85）μg·L-1 in GSH treatment groupwas significantly higher than that in routine treatment group[（41.19±1.80）μg·L-1;P=0.001）].The concentrations of MDA and SOD after GSH treatment were significantly lower than those in routine treatment group[（42.37±1.94）μmol·L-1,（24.14±1.31）KU·L-1;（P=0.003,P=0.001）] respectively.Compared with control group[（40.48±1.48）μg·L-1],the serum level of GSH-Pxwas significantly higher in GSH treatment group（P=0.001）.Conclusion Reduced glutathione has beneficial effects on the treatment of liver injury with acute pancreatitis.The modulating effects of the inflammatory medi a and oxygen free radical may be involved in this mechanism.