| Objective: To explore the effects of DPMAS on circulating Th1,Th2,Thl7 and their effector molecules interferon(IFN-γ、TNF-α、IL-4、 IL-6、IL-10 and IL-17)in patients with acute-on-chronic liver failure by processing peripheral blood samples of patients with liver failure.Methods: From July 2021 to June 2022,patients with acute-on-chronic liver failure diagnosed in the Southwest Hospital affiliated to Youjiang Medical College for Nationalities were collected and treated with DPMAS.The diagnosis of patients with acute-on-chronic liver failure was in accordance with the Guidelines for the Diagnosis and Treatment of Liver Failure(2018).All patients were treated with comprehensive medical treatment combined with DPMAS.The treatment prescription of DPMAS is once a day,and the treatment interval is 1 day,and 2-5 times is a course of treatment.Specific method: After plasma separation,the separated plasma is sent to the disposable BS330 bilirubin adsorber and HA330-II hemoperfusion device for double adsorption,and then returned to the human body.Collect the fasting venous blood of patients before treatment and at the end of DPMAS treatment.The liver function of patients before and after treatment was measured by BS-220 automatic biochemical analyzer,including alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL);Automatic coagulation analyzer was used to detect coagulation function,including prothrombin time(PT)and PTA;Serum IFN-γ、 TNF-α、IL-4、 IL-6、IL-10 and IL-17 was detected by enzyme-linked immunosorbent assay(ELISA);The frequency of Th1,Th2 and Thl7 was analyzed by flow cytometry.Results:(1)This study included a total of 30 cases,all of which were caused by chronic hepatitis B.(2)Comparison of biochemical indexes before and after treatment: CRP(mg/L)after treatment was 6.97 ± 2.54 significantly lower than that before treatment 13.91 ± 5.94(P<0.001),ALB(g/L)after treatment was 32.99 ± 4.33 significantly higher than that before treatment 29.85 ± 4.55(P<0.001),TBIL(umol/L)after treatment was 129.58 ± 39.78 significantly lower than that before treatment 322.73 ± 102.19(P<0.001),and ALT(U/L)after treatment was 131.57 ± 63.03 significantly lower than that before treatment 131.57 ±63.03(P<0.001),After treatment,the AST(U/L)was 131.71 ± 42.37 significantly lower than that before treatment 414.09 ± 156.8(P<0.001),and the PT(s)was 17.34 ± 5.61 after treatment and 15.34 ± 3.75 before treatment,with no significant difference(P>0.05).(3)Comparison of cytokine levels before and after treatment: 16.25 ± 7.43 after treatment of IL-4(pg/ml)was lower than 19.43 ± 7.91 before treatment(P<0.05),11.5 ± 5.26 after treatment of IL-6(pg/ml)was significantly lower than 36.66 ± 13.88 before treatment(P<0.001),37.55 ± 13.18 after treatment of IL-10(pg/ml)was higher than 31.43 ± 9.46 before treatment(P<0.05),4.59 ± 2.4 after treatment of IL-17(pg/ml)was unchanged from 5.52 ±3.18 before treatment(P=0.166),IFN-γ(pg/ml)26.27 ± 7.81 after treatment was significantly lower than 50.06 ± 28.01 before treatment(P<0.001),TNF-α(pg/ml)After treatment of 74.68± 26.98 was significantly lower than 105.13 ± 28.34 before treatment(P<0.001).(4)Comparison of the frequency of different CD4+T cell subtypes before and after treatment:(3.51±1.01)% of CD4+T cells after treatment was significantly lower than that before treatment(5.00 ± 1.23)%(P<0.001),(4.26 ± 1.38)% of Th1 cells after treatment was lower than that before treatment(5.58 ± 0.74)(P<0.01),(10.16 ± 2.5)% of Th2 cells after treatment was lower than that before treatment(12.43 ± 1.74)(P<0.001),and(4.01 ± 0.93)%of Th17 cells after treatment was unchanged from that before treatment(4.29 ± 0.73)%(P>0.05).Conclusion:(1)After treatment with a dual plasma molecular adsorption system,the total bilirubin,alanine aminotransferase,and prothrombin time in the patient’s serum decreased,indicating a recovery in liver function compared to the previous period.(2)After treatment with a dual plasma molecular adsorption system,the cytokines IL-4、IL-6、TNF-α、IFN-γDecrease,increase in IL-10,decrease in both Th1 and Th2 cells,decrease in pro-inflammatory factors,and increase in anti-inflammatory factors,indicating an improvement in immune function.(3)The dual plasma molecular adsorption system can effectively improve the levels of inflammatory factors in the serum,inhibit inflammatory reactions,improve immune function,and promote liver function recovery.It is an effective measure for treating chronic and acute liver failure. |
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