Objective To explore the changes of serum cytokines including endotoxin, TNF-α, IL-18, IL-10, IL-4, NO, SVCAM-1 and SICAM-1 in the peri-operative liver transplantation of liver failure patients after artificial liver therapy (plasma exchange combined with continuous veno-venous hemodiafiltration, PE+CVVHDF),and to investigate the short-term prognosis of artificial liver therapy in the treatment of liver failure patients and its possible mechanism. Methods We selected 54 liver failure patients in peri-operative liver transplantation. Twentythree of them were treated with the artificial liver support system (ALSS) for a total of 61 times (ALSS group), and 31 patients were treated with the routine therapy (routine therapy group). Serum cytokines were determined before and after the treatment. Clinical outcome and changes of serum cytokines including IL-i 0, IL-4, IL-18, TNF-α,endotoxin, NO, SVCAM-1 and SICAM-1 were analyzed. Results The effectiveness rate in a short period of time was 65.22％ in ALSS group, and was 32.26％ in routine therapy group (P＜0.01). In ALSS group after the treatment,IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO and endotoxin decreased significantly (P＜0.01), but the change of serum IL-10 was insignificant (P＞0.05), as compared with those before the treatment. In routine therapy group after the treatment, however, changes of serum IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO, endotoxin and IL-10 were insignificant (P＞0.05), as compared with those before the treatment. In effective patients by ALSS or routine therapy, serum IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO and endotoxin decreased, predominantly in patients treated with ALSS. In ineffective patients after the treatments, however, these serum contents showed no changes. Conclusion ALSS significantly reduces the levels of serum IL-4, IL- 18, TNF-α, VCAM-1, SICAM-1, NO, and endotoxin, alleviates the hepatocyte injury due to inflammatory reaction, and improves the short-term prognosis in liver failure patients. Frequent monitoring serum cytokines will provide useful information for the treatment of liver failure patients.%目的 采用人工肝支持系统(血浆置换+连续性静静脉血液透析滤过)治疗肝移植围手术期的肝衰竭患者,观察治疗前后患者血清中炎症因子、内毒素、内皮细胞功能损伤标志物等水平的变化,探讨人工肝支持系统对肝衰竭患者短期预后的影响及可能机制.方法 选取54例肝移植围手术期的肝衰竭患者,其中23例肝衰竭患者(人工肝组)在肝移植手术前给予人工肝治疗61次,另31例肝衰竭患者(常规组)行常规治疗,观察2组治疗前后炎症因子[白细胞介素18(interleukin 18,IL-18)、IL-10、IL-4、肿瘤坏死因子(tumor necrosis factor α,TNF-α)、一氧化氮(nitric oxide,NO)、可溶性血管细胞黏附分子1(soluble vascular cell adhesion molecule 1,SVCAM-1)、可溶性细胞间黏附分子1(soluble intercellular adhesion molecule 1,SICAM-1)]和内毒素等水平的变化,根据临床症状及体征的改变评判其疗效,并探讨疾病转归与炎症因子和内毒素水平的关系.结果 人工肝组短期有效率65.22%,而常规组短期有效率为32.26%,两组间差异有统计学意义(P＜0.01).治疗后人工肝组IL-4、IL-18、TNF-α、SVCAM-1、SICAM-1、NO和内毒素明显下降,与治疗前比较差异有统计学意义(P＜0.01),IL-10治疗前后差异无统计学意义(P＞0.05);而常规组治疗前后以上指标差异均无统计学意义(均P＞0.05).有效组治疗后血清IL-4、IL-18、TNF-α、SVCAM-1、SICAM-1、NO和内毒素水平较治疗前下降,但人工肝有效组更显著;而无效组患者治疗前后IL-4、IL-18、TNF-α、SVCAM-1、SICAM-1、NO和内毒素水平无变化.结论 内毒素、炎症因子等对肝细胞有继发性损伤作用,肝功能、内皮功能等临床检验指标的改善及临床症状的缓解与血浆IL-4、IL-18、TNF-α和内毒素水平降低有关,人工肝能有效降低炎症因子和内毒素水平,最终改善肝衰竭患者的预后.
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