泰能治疗自发性细菌性腹膜炎时血清和腹水中TNF-α、IL-6及IL-8水平的变化

The Changes of Sera and Ascites Levels of TNF-α IL-6 and IL-8 and Their Significances in Patients with Spontaneous Bacterial Peritonitis Treated with Tienam

目的:观察泰能治疗重型肝炎(SH)并发自发性细菌性腹膜炎(SBP)的疗效并探讨血清和腹水中TNF-α、IL-6及IL-8水平变化的临床意义。方法:采用静脉滴注泰能(0.5g,每日2次,持续7～14天)和腹腔注射泰能(0.5g,每日1次,持续5～7天)治疗SH并发SBP 30例,并于治疗前、后采用放射免疫法(RIA)检测其血清和腹水中TNF-α、IL-6及IL-8水平,以15例非感染性腹水患者作对照。结果:泰能治疗SH并发SBP治愈率为50％(15/30),总有效率为93.3％(28/30),无效率为6.7％(2/30),未治愈患者中10例因发生肝性脑病或肾功能衰竭死亡,5例自动出院。SBP组血清和腹水中TNF-α、IL-6及IL-8水平显著高于非感染性腹水组(P<0.05),且腹水中IL-6、IL-8水平高于血清中的(P<0.05),其升高程度与腹水中白细胞数呈正相关(P<0.01)。感染控制后血清和腹水中TNF-α、IL-6及IL-8水平明显下降(P<0.05)。死亡组血清和腹水中TNF-α、IL-6、IL-8的初始水平显著高于存活组(P<0.05)。结论:泰能治疗SH并发SBP的疗效与血清和腹水中TNF-α、IL-6及IL-8水平密切相关,通过检测上述细胞因子有助于SBP的早期诊断及治疗。

Objective: To evaluate the clinical effect of Teinam in the treatment of patients with severe viral hepatitis (SH) complicated by spontaneous bacterial peritonitis (SBP) and detect the changes of sera and ascites levels of TNF-α、 IL-6 and IL-8 and their significances. Methods: 30 patients were given Teinam 0. 5g Bid intravenously for 7-14 days and 0. 5g Qd intraperitoneally for 5-7 days,the levels of TNF-α、IL-6 and IL-8 in sera and ascites were detected by radioim-munoassay(RIA) before and at the end of the treatment,15 cases without SBP taken as controll. Results:The cure efficacy was 50% (15/30), the total efficacy was 93. 3% (28/30) and the non-efficacy was 6. 7% (2/30), among the without cure patients 10 cases died of hepatic encephalopathy or renal function failure, 5 cases gave up treatment. The levels of TNF-α、 IL-6 and IL-8 in sera and ascites in patients with SH complicated by SBP were significantly higher than those without SBP (P<0. 05), especially the levels of IL-6、 IL-8 in ascites were higher than those in sera (P<0. 05), and the elevated degree of IL-6、IL-8 in ascites were shown positively correlated with PMN(P<0. 01),When infectious were controlled, the levels of TNF-α、IL-6、IL-8 in sera and ascites were significantly decreased (P<0. 05). The original levels of TNF-α、IL-6、IL-8 in sera and ascites of those who died were significantly higher than those who survived (P< 0. 05). Conclusions: The efficacy of Teinam in the treatment of SH complicated by SBP are closely associated with the levels of TNF-α、IL-6、 IL-8 in sera and ascites, to detect those cytokines can be helpful for early diagnosing, judging efficacy and predicting prognosis.