摘要
目的 :观察重型病毒性肝炎患者血清细胞因子的变化 ,探讨血浆置换疗法对患者的影响。方法 :随机选择 4 0例经血浆置换治疗的重型病毒性肝炎患者 ,测定治疗前后血清肿瘤坏死因子 α(TNFα)和白介素 4(IL 4 )的水平 ,观察其与预后、肝功能、并发症间的关系。结果 :4 0例患者经治疗后 TNFα由 (79.32±2 2 .39) ng/L 下降到 (2 0 .0 1± 2 2 .2 5 ) ng/L(P<0 .0 0 1) ,IL 4由 (0 .6 1± 0 .0 7) ng/L 降至 (0 .5 7± 0 .0 6 ) ng/L(P<0 .0 1) ,好转出院的患者较恶化出院的患者下降尤其明显 (P均 <0 .0 5 ) ;肝功能的恢复同样是好转出院的患者较恶化出院的恢复得更好 (P <0 .0 5或 P <0 .0 1) ;对嗜睡、定向能力均有明显改善 (P<0 .0 1和 P <0 .0 5 ) ,对治疗各种并发症更好 (P<0 .0 1)。结论 :血浆置换能清除 TNFα和 IL 4 ,是防治各种并发症的有效措施。预后不佳者与炎症的持续存在导致血清中 TNFα和 IL 4水平较高有关。
Objective:To evaluate the changes of serum cytokines vary with plasma exchange (PE) therapy in patients with severe viral hepatitis.Methods:Forty patients suffering from severe liver failure were randomized and treated by PE therapy The tumor necrosis factorα(TNFα),interleukin4( IL4 ) levels and liver function before and after PE therapy were examined Moreover,the relation of TNFα,IL4 levels and the efficacy of PE,liver function and the compliment were also observed Results:It showed that the TNFα and IL4 level of the serum were decreased after PE therapy The TNFα level of the serum was (79 32 ± 22 39) ng/L before treatment and (20 01±22 25) ng/L after treatment ( P <0 001), IL4 was (0 61±0 07) ng/L before treatment and (0 57±0 06) ng/L after treatment ( P <0 01).There were more differences between recovering patients and worsen ones ( P <0 05 or P <0 01).There was remarkable difference between recovering patients and worsen ones in the liver function improvement ( P <0 05 or P <0 01),the severe symptom ( P <0 01 and P <0 05) and the complication ( P <0 01).Conclusion:PE therapy can effectively purge or reduce TNFα,IL4 and is a method treating and preventing the complication.The worsen patients have continuous inflammation and higher level of TNFα and IL4.
出处
《中国危重病急救医学》
CAS
CSCD
2003年第2期106-108,共3页
Chinese Critical Care Medicine
基金
江苏省常州市医药卫生科技项目资助 (2 0 0 0 160 15 )
