血浆置换治疗对重型病毒性肝炎血清内毒素和炎性介质的影响

Effect of plasma exchange on the plasma levels of endotoxin and inflammatory mediators in patients with severe viral hepatitis

目的 应用血浆置换技术 ,探讨其对重型病毒性肝炎患者体内内毒素和炎性因子水平的影响。方法 5 0例重型病毒性肝炎患者用血浆置换治疗 ,于血浆置换治疗前、治疗结束时、治疗后 2 4小时、4 8小时分别抽血测血清内毒素 (ET)、TNFα及IL - 6的水平。结果 重型病毒性肝炎患者血清内毒素、TNFα、IL - 6的水平明显升高 ,血浆置换治疗结束时血清内毒素、TNFα、IL - 6的水平明显低于治疗前水平 (P <0 .0 5 )。治疗后 4 8小时内毒素、TNFα、IL - 6的水平有所上升 ,但存活组较治疗前明显下降 (P <0 .0 5 ) ,而死亡组与治疗前无明显变化 (P >0 .0 5 )。结论 血浆置换治疗能有效清除重型病毒性肝炎血清内毒素和炎性介质 ,治疗后血清内毒素和炎性介质的水平动态变化可能是判断血浆置换治疗重型病毒性肝炎预后的一个指标。

Objective To investigate the effect of plasma exchange on the plasma levels of endotoxin and inflammatory cytokines , and prognosis of patients with severe viral hepatitis.Methods Fifty patients were treated with plasma exchange. Serum endotoxin and TNFα?IL 6 were measured at the beginning and 0?24?48h post PE.Results Serum levels of endotoxin?TNFα and IL 6 were notably high. Serum concentrations of endotoxin?TNFα and IL 6 were significantly lower after plasma exchange than before plasma exchange. Serum levels of endotoxin?TNFα and IL 6 of 48h post PE were associated with prognosis of severe viral hepatitis.Conclusion Our results showed that plasma exchange is an effective mean of cleaning endotoxin TNFα and IL 6 in treating severe viral hepatitis .The change's trends of the serum levels of endotoxin?TNFα and IL 6 may be an index in judging prognosis of severe viral hepatitis.