Effect of Plasma Exchange with Double Plasma Molecular Adsorption on Cytokines in Autoimmune Hepatitis with Liver Failure
-
摘要:
目的 观察血浆置换（plasma exchange，PE）联合双重血浆分子吸附（double plasma molecular absorb system，DPMAS）对自身免疫性肝炎合并肝衰竭患者细胞因子的影响，探讨血浆置换联合双重血浆分子吸附对此类患者的免疫治疗意义，以及对预后的影响。 方法 选取22例在昆明市第三人民医院于2017年10月至2020年8月期间住院诊断为自身免疫性肝炎合并肝衰竭患者，应用血浆置换联合双重血浆分子吸附治疗，观察结合内科综合治疗前后细胞因子（IL-2、IL-4、IL-6、IL-10、TNF-α）、肝功能、血氨、凝血功能、血常规等指标的变化。 结果 治疗前后对比，患者的细胞因子（IL-2、IL-6、TNF-α）、肝功能（TBIL、AST、ALT、ALB）、血氨、凝血酶原活动度、血红蛋白、血小板等指标经治疗后显著下降，差异有统计学意义（P < 0.05）；治疗前后对比，患者的细胞因子（IL-4、IL-10）、总胆汁酸等指标，差异无统计学意义（P > 0.05）。 结论 应用选择性血浆置换联合双重血浆分子吸附治疗自身免疫性肝炎合并肝衰竭患者，能稳定内环境，为肝细胞的再生能力创造条件，恢复肝功能，改善黄疸等临床症状，能提高患者的生存率，以及肝衰竭的救治成功率，值得推广。 Abstract:Objective To study the effect of Plasma Exchange （PE） combined with Double Plasma Molecular Absorption System （DPMAS） on cytokines in patients with autoimmune hepatitis complicated with liver failure, and to explore the significance of Plasma Exchange combined with Double Plasma Molecular absorption in immunotherapy and the impact on the prognosis of such patients. Methods In this study, 22 patients with autoimmune hepatitis complicated with liver failure who were hospitalized in the Third People’ s Hospital of Kunming City from October 2017 to August 2020 were selected. These patients received plasma exchange combined with double plasma molecular adsorption therapy, and the changes of cytokines （IL-2, IL-4, IL-6, IL-10, TNF-α）, liver function, blood ammonia, coagulation function, blood routine and other indicators before and after the combined medical treatment were analyzed. Results After treatment, the levels of cytokines IL-2, IL-6, and TNF-α, liver function （TBil, AST, ALT, ALB）, blood ammonia, prothrombin activity, hemoglobin, platelet decreased significantly, （P < 0.05）; while the differences in cytokines IL-4 and IL-10）, total bile acid and other indicators were statistically insignificant （P > 0.05）. Conclusion Selective plasma exchage combined with double plasma molecular adsorption in the treatment of patients with autoimmune hepatitis complicated with liver failure helps to maintain homeostasis and supports the regeneration of liver cells, so as to restore liver function and improve clinical symptoms such as jaundice. This method can improve the survival rate of patients, improve the success rate of liver failure treatment, and is worthy of clinical promotion. -
Key words:
- Plasmapheresis /
- Double plasma molecular adsorption /
- Autoimmune hepatitis /
- Liver failure /
- Cytokines
-
表 1 治疗前后细胞因子的比较[（M ± Q），pg/mL]
Table 1. Comparison of cytokines before and after treatment [（M ± Q），pg/mL]
组别 IL-2 IL-4 IL-6 IL-10 TNF-a 治疗前 3.44 ± 3.44 1.06 ± 1.60 31.61 ± 58.56 19.09 ± 24.21 7.05 ± 9.31 治疗后 1.73 ± 2.48 * 0.54 ± 0.90 15.27 ± 31.70* 19.36 ± 22.55 3.47 ± 6.16* 与治疗前比较，*P < 0.05。 
下载: 导出CSV
表 2 治疗前后肝功能的比较[（
$\bar x \pm s$ ）/（M ± Q）]Table 2. Comparison of the liver function before and after treatment [（
$\bar x \pm s$ ）/（M ± Q）]组别 TBIL（μmol/L） AST（U/L） ALT（U/L） TBA（μmol/L） ALB（g/L） 治疗前 388.58 ± 145.90 348.86 ± 299.80 253.86 ± 229.76 298.47 ± 118.77 28.73 ± 3.78 治疗后 180.28 ± 63.84* 125.82 ± 101.2* 111.18 ± 88.43* 278.04 ± 105.91 31.05 ± 2.33* 与治疗前比较，*P < 0.05。
下载: 导出CSV
表 3 治疗前后血氨、凝血酶原活动度、血常规的比较[（
$\bar x \pm s$ ）/（M ± Q）]Table 3. Comparison of the blood routine，blood ammonia and prothrombin activity before and after treatment[（
$\bar x \pm s$ ）/（M ± Q）]组别 血氨（μmol/L） PTA（%） HGB（g/L） PLT（×109/L） 治疗前 58.80 ± 34.24 37.14 ± 12.57 114.91 ± 24.99 153.45 ± 53.75 治疗后 30.85 ± 32.00* 56.77 ± 14.65* 103.23 ± 20.44* 137.00 ± 43.86* 与治疗前比较，*P < 0.05。
下载: 导出CSV
-
[1] 王绮夏,蒋翔,连敏,等. 2015年欧洲肝病学会临床实践指南:自身免疫性肝炎[J]. 临床肝胆病杂志,2015,31(12):2000-2019. doi: 10.3969/j.issn.1001-5256.2015.12.006 [2] 沈含章,张乐. 自身免疫性肝炎及其中西医结合治疗的研究进展[J]. 上海医药,2019,40(5):6-9,70. doi: 10.3969/j.issn.1006-1533.2019.05.003 [3] Latif N,Mehmood K. Risk factor for fulminant hepatic failure and their relation with outcome in children[J]. J Pak Med Assoc,2010,60(3):175-178. [4] Yokokawa J,Saito H,Kanno Y,et al. Overlap of primary biliary cirrhosis and autoimmune hepatitis:Characteristics,therapy,and long term outcomes[J]. J Gastroenterol Hepatol,2010,25(2):376-382. doi: 10.1111/j.1440-1746.2009.06018.x [5] 邹龙,刘洪,马霖杰. 非生物型人工肝的治疗新进展[J]. 中国普外基础与临床杂志,2017,24(5):634-637. [6] 中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝支持系统治疗肝衰竭指南(2016年版)[J]. 中华临床感染病杂志,2016,9(2):97-101. doi: 10.3760/cma.j.issn.1674-2397.2016.02.001 [7] Goral V,Atayan,Kaplan A. The relation between pathogenesis of liver cirrhosis,hepatic encephalopathy and serum cytokine levels:What is the role of tumor necrosis factor α[J]. Hepatogastroenterology,2011,58(107-108):943-948. [8] 自身免疫性肝炎诊断和治疗共识(2015),中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015年版)[J]. 临床肝胆病杂志,2016,32(1):9-21. doi: 10.3969/j.issn.1001-5256.2016.01.002 [9] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊疗指南(2012年版)[J]. 中华肝脏病杂志,2013,21(3):177-183. doi: 10.3760/cma.j.issn.1007-3418.2013.03.006 [10] KR Awitt. Autoimmune hepatitis[J]. N Engl J Med,2006,354(1):54-66. doi: 10.1056/NEJMra050408 [11] 张乐,岳云璇,夏加伟,等. 非生物型人工肝治疗肝衰竭的疗效评价[J]. 昆明医科大学学报,2017,38(1):82-87. doi: 10.3969/j.issn.1003-4706.2017.01.017 [12] 李守娟,王丽,胡朝霞,等. 人工肝联合凉血解毒化瘀方治疗重型乙肝疗效观察[J]. 湖南中医药大学学报,2016,36(6):20-23. doi: 10.3969/j.issn.1674-070X.2016.06.006 [13] 王云,戚应杰,岳莉,等. 人工肝血浆置换与胆红素吸附联合治疗重症肝炎后患者肝功能及HBV-DNA水平变化[J]. 检验医学与临床,2017,14(5):643-645. doi: 10.3969/j.issn.1672-9455.2017.05.016 [14] Bjursten LM,Rasmusson L,Oh S,et al. Titanium dioxide nanotubes enhance bone bonding in vivo[J]. J Biomed Mater Res A,2010,92(3):1218-1224. [15] 雷鹏,段军民,李淑森,等. 血浆置换联合胆红素吸附治疗重型肝炎的疗效观察[J]. 中国现代药物应用,2016,10(20):52-53. [16] Chastre A,Bélanger M,Beauchesne E,et al. Inflammatory cascades driven by tumor necrosis factor-alpha play a major role in the progression of acute liver failure and its neurological complications[J]. PloS One,2012,7(11):e49670. doi: 10.1371/journal.pone.0049670 [17] 陈智. 肝衰竭发生与发展过程中的免疫机制研究进展[J]. 中华肝脏病杂志,2012,20(10):733-736. doi: 10.3760/cma.j.issn.1007-3418.2012.010.005 [18] 李昌明,肖青,韩建魁. 白细胞介素6临床应用进展[J]. 中国误诊学杂志,2007,7(1):30-32. doi: 10.3969/j.issn.1009-6647.2007.01.012 [19] Lai H S,Lin W H,Lai S L,et al. Interleukin-6 mediates angiotensinogen gene expression during liver regeneration[J]. Plo S One,2013,8(7):e67868. doi: 10.1371/journal.pone.0067868 [20] Naveau S,Balian A,Capron F,et a1. Balance between pro and anti-inflammatory cytokines in patients with acute alcoholic hepatitis[J]. Gastroentero1 Clin Biol,2005,29(3):269-274. doi: 10.1016/S0399-8320(05)80760-2 [21] Henning W,Zimmermann,Christian Trautwein,et al. Functional role of monocytes and macrophages for the inflammatory response in acute liver injury[J]. Gastrointestinal Sciences,2012,3(56):103389. [22] 张泽敏,黄仕艺,于兰芳,等. 人工肝血浆置换联合胆红素吸附治疗对重症肝炎患者炎症因子的影响[J]. 中华医院感染学杂志,2014,24(8):1830-1832. -
