【摘要】 目的有研究表明细胞因子及一氧化氮等炎性因子的改变与肝硬化病情发展有关犤1-2犦。为了找到加速肝硬化病情发展的因素,本研究选用细胞因子IL-8、IL-12、TNF-α和NO,对62例不同时期的肝硬化及不同肝功能状况的病人病情与细胞因子及NO的关系进行研究。方法1、病例选择:①代偿期肝硬化17例、失代偿期肝硬化32例、失代偿期肝硬化合并自发性腹膜炎13例,共计62例;②分别测定静脉血浆和腹水中IL-8、IL-12、TNF-α以及血清和腹水中的NO浓度;③研究不同时期的肝便化、肝功能状况与上述细胞因子和NO之间的关系。2、检测方法:细胞因子的测定采用ELISA方法,NO则通过测定血及腹水中的NO2/NO3来估计其水平。结果IL-8、TNF-α和NO在各组肝硬化患者均有不同程度的升高。Child-PughA、B、C三级各组与正常人组相比上述四项参数均有明显升高(P<0.01)。DLC+SBP患者应用抗生素治疗后,可见上述四项参数均有明显降低,治疗前后相比四项参数差异有显著性意义(P<0.01)。5、除IL-12血浆/腹水比值大于1外,各组肝硬化患者血浆细胞因子和血清NO的血浆/腹水比值均小于1。结论代偿期肝硬化IL-12及NO继续升高2倍以上时,可能已发展为失代偿。2、失代偿期肝硬化患者血中IL-8和NO水平显著升高达正常值3倍以上,说明该患者已存在并发症(如SBP)更多还原

【Abstract】 Objective Some researches have indicated that the cytokines and No were relevant with the progression of liver cirrhosis. In order to find out the clues of the progression of cirrhosis, we analyzed systematically studied the cytokines IL-8, TNF-α, IL-12 and NO which could injure the liver cells and discussed the relationship between liver function and cytokines as well as NO. Methods 1. Cases collection: ①Among 62 cases with cirrhosis, compensatory cirrhosis 17, decompensatory cirrhosis without complication 21 and decompensatory cirrhosis associated with SBP 13; ②Detect thd IL-8, IL-12, TNF-α, NO in venous anti-coagulationg serum and ascites; ③Analyze the relationship between the different type of cirrhosis or state of liver function and cytokines as well as NO. 2. Detective methods: The cytokines were detected by classical ELISA. 3. NO detected: Detected the blood / ascites NO2 / NO3, in order to estimate the No level. Results It is apparently that the IL-8, IL-12, TNF-α and NO levels of the other groups of patients with cirrhosis increased (P<0.01). The levels of serum IL-8, IL-12, TNF-α and NO in the serum of Child-Pugh A, B, C were significantly higher than those in the normal control, meanwhile C>B>A. After treated by antibiotics, the serum IL-8, IL-12, TNF-α and NO level decreased significantly. The serum / ascites ratios of IL-8 and TNF-α and No were less than 1, while that of IL-12 was larger than 1. Conclusions 1. If the IL-12 and NO continued to rise sharply twice more highly than the levels of the patients with compensatory cirrhosis, it indicated the advance of cirrhosis from compensatory into decompensatory phase. 2. In cases with decompensatory cirrhosis, if the sharp increase of both IL-8 and TNFα in serum was three times more than those of the normal control, it showed possibility of complication, such as SBP. 3. The amplitude of the increase of cytokines and NO was consistent with the severity of liver function, which was assessed by Child-Pugh criteria. 4. After treated by antibiotics, one or two of the four above-mentioned parameters should be tested so that we could assess the validity of antibiotics and the prognosis of patients with DLC+SBP.更多还原