| Objective: The removal of bilirubin(BIL) in serum of patients with Obstructive Jaundice by CA/PEI affinity membrane was studied. Clearance rates of total bilirubin (TBIL) and direct bilirubin(DBIL), as well as influences of both TBIL and albumin (ALB) concentrations on clearance rates were investigated to evaluate the relieving jaundice effect of CA/PEI membrane. The pre and post adsorption concentrations of cytokine and immune index in serum of patients with chronic hepatic diseases were analyzed to explore preliminarily the effect on disease resistance by CA/PEI membrane.Methods: The experiment was divided into two groups. There were 30 patients with Obstructive Jaundice, aged 32-78, included 18 males and 12 females in the first group, in which 11 cases of Cholelithiasis, 9 cases of Pancreatic cancer, 7 cases of Cholangiocarcinoma and 3 cases of Hepatoma were rolled. ALB and BIL concentrations were measured respectively using bromocresol green method and vanadate method. The above indexes were measured again after static adsorption for 2 hours then calculated and compared the clearance rates and the relationships between TBIL clearance rate with concentrations of TBIL and ALB were identified. There were 20 patients with chronic liver disease associated Jaundice, aged 32-82, included 10 males and 10 females in the second group, in which 9 cases of Decompensated Cirrhosis,6 cases of Liver Cirrhosis combined with Hepatoma, and 5 cases of Chronic Hepatitis B. The effects of CA./PEI membrane absorption on cytokine and immune index were investigated. The pre and post adsorption concentrations of interleukin -6(IL-6), Interleukin -10(IL-10), tumor necrosis factor-α(TNF-α), and transforming growth factor -β1(TGF-β1) were measured by ELISA; IgA, IgM, IgG, C3 and C4 were detected by immune scatter turbidimetry. Results:1. The clearance rates of TBIL and DBIL were 67.35±9.37﹪and 68.91±11.69﹪.2. There was a positive correlation between TBIL clearance rate and TBIL concentration. (r=0.943)3. There was a negative correlation between TBIL clearance rate and ALB concentration. ( r=-0.976)4. The effect of CA/PEI membrane on promoting fibrotic factors: Pre adsorption concentrations of IL-6, TNF-αand TGF-β1 were respectively 88.53±15.73ng/L, 44.80±14.12pg/ml and 63.27±22.35pg/ml, and post adsorption concentrations were respectively 44.56±19.23ng/L, 25.71±10.58pg/ml and 36.17±15.20pg/ml. Significances were showed (P<0.05). Their clearance rates were 49.67±9.70﹪, 42.61±10.23﹪and 34.97±8.96﹪.5. The effect of CA/PEI membrane on inhibiting fibrotic factor: The IL-10 concentrations of pre and post adsorption were 50.69±26.20pg/ml, 39.60±8.70pg/ml and P value was greater than 0.05.6. The effect of CA/PEI membrane on immunoglobulin: The IgA concentrations of pre and post adsorption were 228.50±14.93mg/dl and 299.00±15.94mg/dl; The IgM concentrations of pre and post adsorption were 122.34±6.68mg/dl and 116.61±6.45mg/dl; The IgG concentrations of pre and post adsorption were 1404.86±32.45mg/dl and 1314.50±40.07mg/dl. All of P values were greater than 0.05.7. The effect of CA/PEI membrane on complement: The C3 concentrations of pre and post adsorption were 524.5±38.03mg/L and 660.27±49.25mg/L; the C4 concentrations of pre and post adsorption were 191.15±8.70mg/L , 304.45±18.31mg/L. Both of P values were greater than 0.05.Conclusion:1. CA/PEI membrane had well adsorption for TBIL and DBIL, and the adsorption effect on TBIL and DBIL were similar.2. There was a positive correlation between TBIL clearance rate and TBIL concentration which suggested that the worse Jaundice was and the higher clearance rate was. While there was a negative correlation between TBIL clearance rate and ALB concentration which suggested a higher ALB concentration leading lower adsorption efficiency.3. CA/PEI membrane could clear promoting fibrotic factors, IL-6, TNF-αand TGF-β1 and keep inhibiting fibrotic factor, IL-10. It could improve the ability of anti-liver fibrosis and inhibit the development of chronic liver diseases.4. There was no effect on immunoglobulin and complement during adsorption process. CA/PEI membrane did not interfere with the immunity of patients.5. CA/PEI membrane did not adsorb high molecular weight protein and had a strong anti-pollution ability.6. Some experimental evidence was provided for further research on separation of BIL and ALB.7. The possibility of further modifying of CA/PEI membrane to increase BIL clearance rate was indicated.
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