血浆置换联合血液滤过对乙型肝炎相关慢加急性肝衰竭患者血清IL-17和IL-6的影响

摘要

目的 探讨血浆置换联合血液滤过对乙型肝炎相关肝衰竭血清白细胞介素(IL) -17、IL -6的影响.方法 30例乙型肝炎慢加急性肝衰竭患者在内科治疗的基础上采用血浆置换联合血液滤过单次治疗.用ELISA检测各组血清IL - 17、IL -6浓度,同时记录血清ALT、TBil等值并进行统计分析.结果 肝衰竭组患者血清IL - 17、IL -6水平分别为(123.5 ±23.0) pg/ml、(110.0±18.5)pg/ml,高于慢性乙型肝炎患者(48.5 ±6.3 )pg/ml、(27.8±5.9) pg/ml和正常对照组(34.7 ±3.3)pg/ml、( 12.1 ±5.1) pg/ml,P均＜0.001；治疗后血清IL - 17、IL -6水平分别为(84.7±21.4) pg/ml、( 75.8±16.6) pg/ml,较治疗前下降(t=35.1,P＜0.001；t=33.4,P＜0.001)；与好转组相比,人工肝对恶化组血清IL - 17、IL -6清除效率降低(t=3.8,P＜0.05;t=3.9,P＜0.05)；人工肝对血清IL - 17、IL -6清除效率均与MELD评分呈负相关(r=-0.53、P=0.003;r=-0.43,P=0.015).结论 血浆置换联合血液滤过能有效降低肝衰竭患者血清IL - 17、IL -6水平,其对IL -17、IL -6的清除效率可能与患者预后有关.%Objective To determine whether plasma exchange combined with hemofiltration influences the peripheral blood levels of inter-leukin (IL) - 17 and/or IL -6 in patients with hepatitis B virus ( HBV) - related acute - on - chronic liver failure ( ACLF) and investigate its clinical significance. Methods Thirty patients diagnosed with HBV - related ACLF received a single treatment of plasma exchange combined with hemofiltration. This group was subdivided according to 72 h outcomes of improvement ( n = 19) or deterioration ( n = 11) . Control groups were composed of chronic hepatitis B patients (CHB; n = 19) and healthy individuals (HC; n =20). Blood samples were collected from all study participants to measure concentrations of IL - 17 and IL - 6 by enzyme - linked immunosorbent assay and biochemical parameters with an automatic analyzer. Intergroup differences were statistically analyzed for significance. Results IL -17 and IL-6 were markedly up - regulated in the HBV - related ACLF group compared with the CHB and HC groups. The plasma exchange combined with hemofiltration treatment significantly reduced the serum concentrations of IL - 17 and IL-6 (vs. Pre -treatment levels: t = 35. 1 , P <0. 001 and t =33.4, P <0. 001 , respectively). In addition, the indexes of extracorporeal removal of IL - 17 and IL-6 were higher in the improved subgroup than in the deterioration subgroup (t = 3. 8, P < 0. 05 and t = 3.9 , P < 0. 05 , respectively) and were negatively associated with the MELD score of the HBV - related ACLF patients in both subgroups (r=0.53, P < 0. 05 and r = 0. 43 , P < 0. 05 , respectively ) . Conclusion The enhanced serum concentrations of IL - 17 and IL-6 in HBV - related ACLF patients were markedly reduced by a single treatment of plasma exchange combined with hemofiltration. The removal efficiency of plasma exchange combined with hemofiltration for serum IL - 17 and IL-6 may be a short - term prognostic indicator of HBV - related ACLF patients, possibly due to the reduced risk of inflammation - related damage mediated by these two cytokines.