The Research Of Artificial Liver Plasma Exchange’s Effect On TNF-α, IL-6, IFN-γ Of Liver Failure Patients

Object Through detecting the serum level of interleukin6(IL-6), tumor necrosisfactor alpha (TNF-α) and interferon gamma (IFN-γ) of hepatic failure patients beforeand every the next morning after plasma exchange treatment (Plasma exchange, PE),and simultaneous detecting of liver function indicators, prothrombin activity PTA,record the main clinical manifestations. Analysis the relationship between three kindsof cytokines level with their liver function, PTA and clinical manifestations. To furtherexplore the pathophysiological mechanism of the development of liver failure and thesignificance of artificial liver support system in the treatment of hepatic failure.Methods36patients with liver failure were studied. These patients include3cases ofacute liver failure,7cases of subacute liver failure,22cases of (sub)acute-on-chronicliver failure and4cases of chronic liver failure. The blood samples of each patientwere measured prior to the PE therapy and in the following morning after multipletreatments. ELISA method was used to measure the levels of serum TNF-alpha, IL-6,and IFN-γ. automatic biochemical analyzer was used to measure the levels of liverfunction, PTA was detected by automated blood coagulation analyzer. Andsimultaneous detecting TNF-α, IL-6, IFN-γ, liver function and PTA of30healthypersons.Results1、The level of TNF-α, IL-6, IFN-γ and main liver function of liver failurepatients before plasma exchange therapy was higher than healthy person. The level ofPTA was lower than healthy person. The differences were statisticallysignificant(P<0.05).2、Of36cases of liver failure patients, before PE treatment the level respectivelywere381.23±190.57ng/L,77.9±83.09ng/L,534.65±471.19ng/L, after treatmentwere274.12±212.30ng/L,54.8±63.32ng/L,259.65±312.26ng/L. There aresignificant difference between prior and after treatment (P<0.05),29cases weredecrease significantly in TNF-α, IL-6, IFN-γ after treatment, the clinical manifestations of the patients after treatment were significantly improved also. Theother7cases of patients were not seen obvious changes in cytokines (P>0.05),patients manifestations were not better yet,3cases died,4cases discharged.3、Before and after plasma exchange treatment，the indexes of liver function andprothrombin activity shows significantly difference in the recovery group(P<0.05),liver function and prothrombin activity did not change significantly in deteriorationgroup, the difference was not statistically significant (P>0.05).4、The fall of IL-6, TNF-α were significantly different in early, middle and late stageof liver failure group(P<0.05). The decline of IFN-γ between early group andmid-group was not significant(P>0.05), however，the IFN-γ difference between earlygroup and the late group, medium group and the late group was significance (P<0.05).5、After conventional medical therapy plus plasma exchange, the efficiency of acuteliver failure, subacute liver failure, acute on chronic(subacute) liver failure andchronic liver failure were66.67%、85.71%、86.36%、50.00%.6、Levels of three cytokines are positively correlated with ALT、AST、TBIL，andnegatively correlated with the prothrombin activity. Three cytokines levels closelycorrelated with clinical performance. After Plasma exchange, three cytokinesdecreased, the patient’s condition shows significant improvement, The level ofcytokines isn’t significant decline showed no significant improvement or deteriorationin manifestations.Conclusions The level of TNF-α, IL-6, IFN-γ was significantly increased in patientswith liver failure. Continual plasma exchange treatment can effectively remove theplasma pro-inflammatory cytokines TNF-α, IL-6and IFN-γ, improve clinicalmanifestations. TNF-α, IL-6and IFN-γ may play a role in the development of liverfailure.