乌司他丁对肝脏肿瘤切除术患者肝脏缺血-再灌注损伤时IL-1β、IL-6、TNF-α及肝功能的影响

Effects of ulinastatin on the level of IL-1β,IL-6,TNF-α and liver function in patients undergoing hepatectomy during hepatic ischemia-reperfusion

目的:探讨乌司他丁对肝脏肿瘤切除术患者肝脏缺血-再灌注损伤时白细胞介素1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)及肝功能的影响。方法:将拟行肝脏肿瘤切除术的76例患者随机分为观察组(n=38)和对照组(n=38)。观察组用乌司他丁,对照组用异甘草酸镁注射液。比较两组手术情况、炎症因子水平、肝功能、内皮功能及氧化应激指标。结果:两组患者出血量、肝门阻断时间、手术用时比较,差异无统计学意义(P>0.05);观察组于术后10 min、1 h、1 d、2 d四个时点的IL-1β、IL-6、TNF-α水平,肝功能指标及血管内皮素-1(ET-1)均低于对照组(P<0.05),但一氧化氮(NO)水平却高于对照组;观察组超氧化物歧化酶(SOD)水平高于对照组,其中术后1 h、1 d、2 d三个时点比较,差异具有统计学意义(P<0.05);观察组丙二醛(MDA)水平低于对照组,其中术后1 d、术后2 d两个时点比较,差异具有统计学意义(P<0.05)。结论:乌司他丁可有效控制并减轻肝脏缺血-再灌注损伤,保护肝功能,减少术后并发症,改善手术预后。

Objective:To investigate the effect of ulinastatin on the changes of Interleukin-1β(1L-1β),Interleukin-6(1L-6),tumour necrosis factor-α(TNF-α)and liver function in the period of hepatic ischemia-reperfusion injury in patients undergoing liver tumor resection.Methods:A total of 76 patients undergoing liver tumor resection were randomly divided into observation group(n=38)and control group(n=38).The observation group was treated with ulinastatin while the control group was treated with magnesium isoglycyrrhizinate injection.The operation condition,inflammatory factor level,liver function index,endothelial function and oxidative stress index were compared between the two groups.Results:There was no significant difference between the two groups in blood loss,hepatic portal blocking time and operation time(P>0.05).At four time points of 10 min,1 h,1 d and 2 d after operation,IL-1β,IL-6,TNF-α,liver function index and vascular endothelin(ET-1)in the observation group were lower than those in the control group(P<0.05),but the level of nitric oxide(NO)in the observation group was higher than that in the control group.The level of superoxide dismutase(SOD)in the observation group was higher than that in the control group at the three time points of 1 h,1 d and 2 d after operation(P<0.05).The levels of Malondialdehyde(MDA)both in 1 d and 2 d after operation in the observation group were lower than those in the control group(P<0.05).Conclusion:Ulinastatin can effectively control and alleviate liver ischemia-reperfusion injury,thus protecting liver function,reducing postoperative complications and improving surgical prognosis.