双重血浆分子吸附系统对慢加急肝衰竭患者血清炎性因子、肝功能及免疫功能的影响

Effect of dual plasma molecular adsorbent system on serum inflammatory factors,liver function and immune function in patients with chronic liver failure

目的观察双重血浆分子吸附系统对慢加急肝衰竭患者血清抗炎因子和促炎因子的影响。方法选择2015年8月—2016年10月四川省自贡市第一人民医院感染科诊治的慢加急肝衰竭患者80例作为研究对象,按抽签法随机分成对照组与观察组,各40例,对照组采用血浆置换治疗,观察组采用双重血浆分子吸附系统治疗,观察2组临床疗效、血清炎性因子、肝功能、免疫功能及不良反应。结果治疗后,观察组有效率高于对照组(87.50%vs.67.50%,χ~2=4.587,P=0.032)。观察组血清IL-10、IL-17、TGF-β、CD4^+、CD4^+/CDB^+高于对照组[(131.40±13.62)ng/L vs.(119.70±12.57)ng/L,(261.40±23.21)ng/L vs.(251.26±20.85)ng/L,(180.43±23.58)mg/L vs.(162.27±21.48)mg/L,(35.43±4.85)%vs.(32.31±4.20)%,(1.24±0.28)vs.(1.09±0.21),t=3.992、2.055、3.600、3.174、2.710,P=0.000、0.043、0.000、0.002、0.008],观察组CRP、IL-6、TNF-α、ALT、DBil、TBil、CDB^+低于对照组[(16.30±3.27)mg/L vs.(19.61±4.10)mg/L,(8.60±1.13)ng/L vs.(16.50±2.25)ng/L,(142.61±21.08)mg/L vs.(158.30±23.60)mg/L,(151.49±15.43)IU/L vs.(170.78±16.32)IU/L,(149.30±16.50)μmol/L vs.(169.23±17.14)μmol/L(228.54±18.11)μmol/L vs.(240.51±19.67)μmol/L,(28.26±4.50)%vs.(31.19±4.87)%,t=3.991、19.844、3.135、5.432、5.298、2.831、2.794,P=0.000、0.000、0.000、0.000、0.000、0.000、0.006]。2组不良反应比较差异无统计学意义(P>0.05)。结论双重血浆吸附系统能够有效清除慢加急肝衰竭患者促炎因子,促进抗炎因子的表达,恢复二者动态平衡。

Objective To observe the effect of double plasma molecular adsorbent system on serum anti inflammatory factors and proinflammatory factors in patients with chronic liver failure.Methods From August 2015 to October 2016, 80 cases with acute or chronic liver failure in Zigong First People＆#39;s Hospital of Sichuan province enrolled as the research object, they were randomly divided into control group and observation group, 40 cases in each group, the control group using plasma exchange treatment, observation group used double plasma molecular adsorption systematic treatment, adverse reaction, clinical observation, 2 groups of serum inflammation factor, liver function, immune function were compared.Results After treatment, the effective rate of the observation group was 87.50%, which higher than that of the control group＆#39;s 67.50% （χ^2=4.587, P =0.032）.Observation group＆#39;s IL-10, IL-17, TGF-β, CD4^＋, CD4^＋/CD8^＋ higher than that of the control group[（131.40±13.62）ng/L vs.（119.70±12.57）ng/L,（261.40±23.21）ng/L vs.（251.26±20.85）ng/L,（180.43±23.58）mg/L vs.（162.27±21.48）mg/L,（35.43±4.85）% vs.（32.31±4.20）%,（1.24±0.28） vs.（1.09±0.21）, t=3.992, t =2.055, t =3.600, t =3.174, t =2.710, P =0.000, P =0.043, P =0.000, P =0.002, P =0.008],observation group＆#39;s CRP, IL-6, TNF-α, ALT, DBil, TBil, CD8^＋ lower than that of the control group[（16.30±3.27）mg/L vs.（19.61±4.10）mg/L,（8.60±1.13）ng/L vs.（16.50±2.25）ng/L,（142.61±21.08）mg/L vs.（158.30±23.60）mg/L,（151.49±15.43）IU/L vs.（170.78±16.32）IU/L,（149.30±16.50）μmol/L vs.（169.23±17.14）μmol/L,（228.54±18.11）mol/L vs.（240.51±19.67）mol/L,（28.26±4.50）% vs.（31.19±4.87）% , t =3.991, t =19.844, t =3.135, t =5.432, t =5.298, t =2.831, t =2.794, P =0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0.006].There was no significant difference in adverse reactions between the 2 groups （P 〉0.05）.Conclusion Dual plasma adsorption system can effectively eliminate the proinflammatory factors in patients with chronic liver failure, promote the expression of anti-inflammatory factors, and restore the dynamic balance between the two groups.