急性胰腺炎肝损害与血清il-18、tnf-α、no的关系

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1、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-

2、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

3、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；NOTheRelationshipBetweenAcutePancreatitisLiveDamageandIL-18,TNF-αandNOJiangLiangMei-FenLaiHongHuangAbstactObj

4、ective:Toresearchtherelationshipbetweenacutepancreatitis(AP)liverdamageandIL-18,TNF-αandNOlevelsinserum.Methods:87casesAPpatientswereassignedintotwogroupsasmild(MAP)andsevere(SAP)group.50caseshealthycontrolswerealsoinvolvedinthisstudy.TheserumlevelsofIL-18andTNF-αwere

5、determinedbyenzymlinkedimmunosorbentassay(ELISA),andthelevelsofNOwasmeasuredbynitratereductasemethod.TheserumlevelsofALT、AST、TB、ALB、LDH、AKPandγ-GTwerealsomeasured.Results:Theincidencerateofliverdamagein87casesofAPwas62.06%.TheserumlevelsofleverfunctioneitherbetweenAPg

6、roupandcontrolgrouporbetweenSAPgroupandMAPgroupweresignificantlydifferentbeforetreatment(allP＜0.01).TheALBlevelinSAPwereincreasedaftertreatment（P＜0.01),andthelevelsoftheotherliverfunctioninthebothAPgroupwerealldecreased（allP＜0.01）.TheserumlevelofIL-18,TNF-αandNOinAPgr

7、oupwerehigherthanincontrol（P＜0.01)anddecreasedaftertreament（P＜0.01).InAPpatientswithliverdagame,thelevelsofIL-18,TNF-αandNOweremuchhigherthaninpatientswithoutliverdamageandcontrolsgroup（allP＜0.01）.ThepositivecorrelationwasdiscoveredbetweenserumlevelsofIL-18,TNF-α,NOan

8、dALTorASTamongAPpatientswithliverdamage,andtheIL-18hadpositivecorrelationwithTNF-αorNO.Conclusion:Theincidencerateofliverdam