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双重血浆吸附联合血浆置换对肝衰竭患者细胞因子表达及肝功能的影响
作者:赵婧婷  王莉  余洪烈 
单位:自贡市第三人民医院 肾病科, 四川 自贡 643020
关键词:肝衰竭 血浆置换 双重血浆吸附 细胞因子 
分类号:R575.3
出版年·卷·期(页码):2020·48·第十期(1264-1267)
摘要:

目的:观察双重血浆吸附(DPMAS)联合血浆置换治疗后对肝衰竭患者细胞因子表达及肝功能的影响。方法:回顾性选择2015年1月至2017年10月在本院治疗的肝衰竭患者60例,观察患者DPMAS联合血浆置换治疗的临床疗效及对细胞因子[白细胞介素(IL)-4、IL-6、肿瘤坏死因子-α(TNF-α)及IL-10]及肝功能的影响。结果:治疗后患者乏力、纳差、腹胀、黄疸等临床症状均有不同程度的改善,好转46例(好转率76.67%),未愈自动出院11例,死亡3例,联合治疗后患者的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、直接胆红素(DBil)、胆汁酸(TBA)、总胆红素(TBil)与治疗前比较差异均有统计学意义(P<0.05);治疗后患者的血清细胞因子(IL-4、IL-6、TNF-α、IL-10)与治疗前比较差异均有统计学意义(P<0.05);出现不良反应11例次,经对症处理后均得到缓解。结论:DPMAS联合血浆置换治疗肝衰竭,可有效清除患者促炎性细胞因子,改善患者的肝功能,一定程度上缓解患者的临床症状,值得临床关注。

Objective: To observe the effects of double plasma molecular adsorption system(DPMAS) combined with plasma exchangeon cytokines expression and liver function in patients with liver failure. Methods: 60 patients with hepatic failure treated in our hospital from January 2015 to October 2017 were selected, the clinical efficacy, serum cytokines including interleukin(IL)-4, IL-6, tumor necrosis factor α(TNF-α), IL-10 and liver function after treatment were analyzed.Results: After treatment, the symptoms such as fatigue, anorexia, abdominal distension, jaundice and ascites were improved. Among the 60 patients,46 cases were improved after treatment(the improvement roote was 76.67%), 11 cases were discharged automatically and 3 cases died. The changes in liver function indexes[alanine transaminase(ALT), aspartate transaminase(AST), direct bilirubin(DBiL), total bile acid(TBA) and total bilirubin(TBil)] were statistically significant(P<0.05). The changes in serum cytokines(IL-4, IL-6, TNF-α, IL-10) were statistically significant(P<0.05). Adverse reactions occurred in 11 patients,and all were relieved after expectant treatment.Conclusion: DPMAS combined with plasma exchange for liver failure can effectively decrease the levels of pro-inflammatory cytokine in patients. It also improves the liver function and relieves the clinical symptoms, which deserves clinical attention.

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