The Influence Of Plasma Exchange On Serum Inflammatory Cytokines Levels And Survival State In Patients With Acute Liver Failure

OBJECTIVE:1. To probe into the relationship between inflammatory cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-18, gamma-interferon (IFN-gamma), IL-10 and liver injure. 2. To investigate the levels of serum cytokines and biochemical parameters varying with plasma exchange (PE) therapy in patients with acute liver failure. 3. To evaluate the influence of plasma exchange on survival time and survival rate in patients with acute liver failure. Methods:1. The serum levels of the cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-18, gamma-interferon (IFN-gamma), IL-10 were measured in 62 patients with acute liver failures (ALF), 14 patients with chronic viral hepatitis and 13 healthy volunteers by enzyme linked immunosorbent assay. 62 cases of ALF were treated with 96 times of plasma exchange(PE) , The serums before, after plasma exchange and 7-10 days after plasma exchange were collected to detect liver function and prothrombin time, ammonia and the levels of TNF-alpha, IL-18, IL-10, and gamma-interferon (gamma-1FN), and the patients with ALF in different stage both PE group and control group were graded with Model End-stage Liver Disease(MELD). 3. The efficacyof plasma exchange was evaluated by comparing the MELD scores , survival rate and survival time of PE group with the control group. RESULTS: 1. Serum TNF-alpha, IL-18, IFN-gamma levels in patients with ALF were significantly more elevated than in those with chronic viral hepatitis and healthy volunteers. Elevated serum IL-10 levels were restricted in patients presenting with ALF, and serum IL-10 levels in surviving cases were significantly higher than in death cases (P < 0. 05). 2. The serum total bilirubin, alanine aminotransferase (ALT), ammonia and MELD scores were significantly lower (P< 0.05)and the prothrombin time significantly shorten, the serum gamma-IFN and IL-18 levels decreased after PE therapy (P < 0. 01). There was no difference in serum TNF-alpha, IL-10 levels between before and after plasma exchange. Comparing with the control group, the mortality did not significantly decrease, the MELD scores 60 90 days after PE therapy were significantly lower (P < 0.05), the survival time was significantly longer in PE group (P < 0. 05). CONCLUSION:1. Pro-inflammatory cytokine TNF-alpha, IL-18 and IFN-gamma are involved in the pathogenesis of acute liver failure in humans, The anti-inflammatory cytokine IL-10 is able to attenuate the development of liver injury.2. PE can effectively purge or reduce pro-inflammatory IL-18, IFN-gamma ,was helpful to correct coagulopathy and improve liver...