The Investigation Of Effects Of Artificial Liver Support System On The Serum SFas/sFasL Of Patients With Severe Hepatitis

Background: The apoptosis (APO) is a biological phenomenon of cell death, there are many kinds of diseases such as cancer, neurological diseases, immune disorders, microbial infection are related to APO. Current researches show that Fas and its'ligand(FasL) is a definitely system involving in APO. Fas can specificlly combine with anti-Fas monoclonal antibody or FasL, evoke the transduction of death signal and finaly induce the APO of cells. As well as the membrane form of Fas, there is a soluble type Fas element(sFas), whose role is to fight against Fas antibodies or FasL-induced apoptosis. Soluble FasL (sFasL) is transformed from membrane type of FasL or secreated by involved cells. Some prospective studies show that the content of sFas and sFasL were increased when hepatitis patients in a serious condition. While the condition of patient improved after treatment, it was found that the content of sFas and sFasL was dropped. It was thinked that sFas and sFasL involved in the progression of severe hepatitis. However, there is seldom report about the effect of the artificial liver support system(ALSS) on serum sFas and sFasL in patients with severe hepatitis.Objective: The major purpose of this study was to confirm the role of sFas and sFasL in the progression of severe hepatitis, and investigate effect of the ALSS on serum sFas and sFasL in patients with severe hepatitis.Methods: 32 cases of severe hepatitis patients were treated with ALSS(continuous intravenous plasma exchange hemofiltration), and 27 cases of severe hepatitis teated without ALSS were choosen as control group. These two groups were treated with the same basic medicine therepeutic methods. The clinical outcome, seral level of sFas, sFasL and the liver function tests were analysed. 10 healthy persons were selceted as mormal control.Results: 1.Clinical outcom: the effctive rate of ALSS groups was 71.88%, while it was 37.04% in the non-ALSS groups, there was significant difference (P <0.01). 2.Liver function test: after treatment, TBL, ALT, PTA and ALB were improved significantly (P <0.01) in the ALSS group; and compared with the non-ALSS group there was a significant difference (P <0.01). 3.Before and after treatment, there was a significant reduction of sFas and sFasL (P <0.01) in ALSS group; and there was a significant difference (P <0.01) compared with the non-ALSS group. 4. After ALSS, there was no significant difference between the good effective patients and the the poor effective patients (P> 0.05); but the concentration of sFasL had a significant difference (P <0.05). 5.There was a significant difference between the poor effecttive patients with ALSS and the poor effective patients of the non-ALSS after treatment (P <0.05); but there was no significant differences about the concentration of sFasL (P> 0.05). 6.Before treatment, there were significant differences of sFas between 25 cases of sub-acute and 34 cases of acute hepatitis (P <0.05); but there was no significant difference of sFasL (P> 0.05).Conclusion: 1.ALSS can markedly improve the outcome of the patients with severe hepatitis. 2. ALSS can remove the sFas, sFasL, and probably block the Fas-mediated liver cell apoptosis.