急性胰腺炎肝损害与血清IL.doc

急性胰腺炎肝损害与血清IL-18、TNF-α、NO的关系 （血清IL-18水平的变化在急性胰腺炎肝损害中的应用价值） 梁 坚1 周宇1赖美芬1 陈洁2 （1．消化内科 2..检验科） 广东医学院附属医院 （广东湛江 524001） 摘要 目的：探讨急性胰腺炎（AP）肝损害与IL-18、TNF-α、NO变化的关系。方法：87例AP患者分轻、重型（MAP、SAP）两组，设正常对照组50例，采用酶联免疫吸附试验法（ELISA）检测IL-18、TNF-α水平，采用硝酸还原酶法检测NO水平，同时测定血清肝功能指标（ALT、AST、TB、ALB、LDH、AKP、γ-GT）。结果：87例患者合并肝功能损害者54例（62.06%）。AP患者与对照组比较，治疗前SAP组与MAP组比较，血清各肝功能指标水平有显著差异（P＜0.01），治疗后SAP组血清ALB较治疗前升高（P＜0.01），SAP组和MAP组肝功能其他指标均明显下降（P＜0.01）；血清IL-18、TNF-α、NO水平AP组显著高于对照组（P＜0.01），治疗后显著低于治疗前（P＜0.01）；AP合并肝损害组显著高于对照组及无肝损害组（P＜0.0）；AP肝损害患者血清IL-18、TNF-α、NO与血清ALT、AST呈正相关，IL-18与TNF-α、NO呈正相关。结论：AP患者肝损害发生率高，SAP肝损害程度明显高于MAP，AP肝损害患者血清IL-18、TNF-α、NO水平明显升高，升高程度与病情严重程度呈正相关；检测血清IL-18、TNF-α、NO可作为AP肝损害诊断、判断病情轻重程度及预后的指标。 关键词 急性胰腺炎；肝损害；IL-18；TNF-α；NO The Relationship Between Acute Pancreatitis Live Damage and IL-18,TNF-αand NO Jiang Liang Mei-Fen Lai Hong Huang Abstact Objective: To research the relationship between acute pancreatitis(AP) liver damage and IL-18, TNF-α and NO levels in serum. Methods: 87 cases AP patients were assigned into two groups as mild(MAP) and severe(SAP) group. 50 cases healthy controls were also involved in this study. The serum levels of IL-18 and TNF-αwere determined by enzym linked immunosorbentassay(ELISA), and the levels of NO was measured by nitrate reductase method. The serum levels of ALT、AST、TB、ALB、LDH、AKP and γ-GT were also measured. Results:The incidence rate of liver damage in 87cases of AP was 62.06%. The serum levels of lever function either between AP group and control group or between SAP group and MAP group were significantly differentbefore treatment(all P＜0.01).The ALB level in SAP were increased after treatment（P＜0.01),and the levels of the other liver function in the both AP group were all decreased（all P＜0.01）.The serum level of IL-18, TNF-α and NO in AP group were higher than in control（P＜0.01) and decreased after treament（P＜0.01).In AP patients with liver dagame,the levels of IL-18, TNF-α and NO were much higher than in patients without liver damage