The Significance Of Changes In Cytokine Levels Before And After Artificial Liver Treatment For The Timing Of Treatment And The Prediction Of Short-term Curative Effects In Patients With Liver Failure

Objective: By observing the changes of serum cytokines sIL-2R,IL-1?,IL-6,IL-8,IL-10 and TNF-? before and after artificial liver treatment in patients with liver failure,to investigate the clinical value of cytokines in guiding the timing of artificial liver treatment in patients with liver failure and predicting the short-term prognosis.Methods:A total of 82 patients with liver failure admitted to The First Affiliated Hospital of Nanchang University from December 2018 to December 2019 were selected.According to the prognosis,the patients were divided into the improvement group(41 cases)and the deterioration group(41 cases).Patients in the two groups were treated with the artificial liver method of conventional medical treatment and plasma exchange combined with bilirubin adsorption.To observe and analyze the changes of the clinical manifestations,liver function(ALT,AST,TBil,DBil,A/G),coagulation function(INR,PTA)in the two groups of patients at the time of admission,before the first artificial liver treatment,1 week after the first artificial liver treatment and before discharge.To observe and analyze the changes of cytokines(sIL-2R,IL-1?,IL-6,IL-8,IL-10 and TNF-?)in the two groups of patients at the time of before the first artificial liver treatment,1 week after the first artificial liver treatment.Results:1.ALT,AST,TBil and DBil in all the patients decreased in 1 week after the first treatment(P<0.05),while A/G and PTA increased in all the patients(P<0.05).2.Comparison of cytokine levels between the two groups before and after the first artificial liver treatmentThe levels of cytokines before the first artificial liver support treatment and 1week after the treatment were higher in the deterioration group than in the improvement group(P<0.05).The levels of sIL-2R,IL-6,IL-8 and TNF-? in all patients after the first artificial liver treatment were lower than those before treatment(P<0.05),and the levels of IL-10 were higher than those before treatment(P<0.05).And there was no significant difference between the two groups in the improvement levels of all cytokines before and after treatment(P>0.05).3.Correlation analysis of cytokines and prognosis of patients with liver failureAccording to logistic regression analysis,cytokines sIL-2R and IL-6 were independent prognostic risk factors(P<0.05),and the higher the level of increase,the worse the prognosis.Conclusion: Plasma exchange combined with bilirubin adsorption can significantly improve the clinical symptoms,liver,renal function and coagulation function of patients with liver failure,and effectively reduce the level of pro-inflammatory factors,and restore the balance of pro-inflammatory factors and anti-inflammatory factors to a certain extent.Serum levels of cytokines sIL-2R and IL-6 can predict the short-term efficacy of patients,while patients with high levels of sIL-2R and IL-6 have poor prognosis,requiring further artificial liver treatment to improve the condition.sIL-2R and IL-6 are independent risk factors for prognosis.Dynamic monitoring of sIL-2R and IL-6 levels is helpful to the choice of timing of artificial liver treatment and improve the prognosis of patients.