摘要
目的探讨乌司他丁对具有肝硬化背景的原发性肝癌(PLC)患者肝部分切除术围术期免疫功能、炎症因子、肝功能和疾病转归的影响。方法将68例择期行肝部分切除术的具有肝硬化背景的PLC患者随机分成观察组和对照组,各34例。对照组围术期给予常规治疗,观察组在对照组的基础上加用乌司他丁辅助治疗。观察两组患者术前、术后3 d、术后7 d的免疫功能、炎症因子、肝功能的变化,以及两组的疾病转归情况。结果术前,两组患者的超敏C反应蛋白、白细胞介素6、肿瘤坏死因子α、可溶性白细胞介素2受体等炎症指标,CD4^(+)、CD4^(+)/CD8^(+)比值、IgG、IgA等免疫指标,ALT、AST、总胆红素和总胆汁酸等肝功能指标水平比较,差异均无统计学意义(均P>0.05);术后3 d和7 d时,观察组的上述炎症指标和肝功能指标水平低于对照组,免疫指标水平均高于对照组(均P<0.05)。观察组的术中输血量和术后住院时间均少于或短于对照组(均P<0.05),但两组的围术期死亡、并发症及不良反应的发生率比较,差异均无统计学意义(均P>0.05)。结论具有肝硬化背景的PLC患者在肝部分切除术围术期应用乌司他丁进行辅助治疗,能显著地抑制机体炎症反应、调节免疫功能、改善肝脏功能,有助于改善患者的预后,且安全性高。
Objective To investigate the effect of ulinastatin on immune function,inflammatory factors,liver function and disease outcome during perioperative period of partial hepatectomy among primary liver cancer(PLC)patients with prior or existing cirrhosis.Methods Sixty-eight PLC patients with prior or existing cirrhosis,who underwent selective partial hepatectomy,were randomly divided into observation group(n=34)and control group(n=34).The control group was given conventional therapy in perioperative period,whereas the observation group was treated with adjuvant ulinastatin additionally based on the therapy performed in the control group.Changes in immune function,inflammatory factors,liver function before operation,three and seven days after operation,as well as disease outcome,were observed in the two groups.Results Before operation,no statistically significant differences were found between the two groups in inflammation indicators,such as high-sensitivity C-reactive protein,interleukin 6,tumor necrosis factorαand soluble interleukin 2 receptor,immune indicators,such as CD4^(+),CD4^(+)/CD8^(+)ratio,IgG and IgA,or liver function indicators,such as ALT,AST,TBIL and total bile acid(all P>0.05);three and seven days after operation,the observation group exhibited lower levels of the aforementioned inflammation indicators and liver function indicators,and higher levels of immune indicators as compared with the control group(all P<0.05).The observation group had less intraoperative blood infusion volume and shorter postoperative hospital stay than the control group(all P<0.05),however,there was no statistically significant difference in perioperative mortality rate,incidence rate of complications,or incidence rate of adverse reactions between the two groups(all P>0.05).Conclusion For PLC patients with prior or existing cirrhosis,the application of adjuvant ulinastatin therapy in perioperative period of partial hepatectomy can significantly inhibit inflammatory response in the body,regulate immune function,improve liver fu
作者
李敏
许忠玲
励耀
蔡晓兰
LI Min;XU Zhong-ling;LI Yao;CAI Xiao-lan(Rugao Fourth People′s Hospital,Rugao 226500,China;Department of Anesthesiology,Affiliated Hospital of Nantong University,Nantong 226001,China)
出处
《广西医学》
CAS
2021年第16期1940-1944,共5页
Guangxi Medical Journal
基金
江苏省南通市科技计划(JC2018055)。
关键词
原发性肝癌
肝硬化
乌司他丁
肝部分切除术
肝功能
炎症因子
免疫功能
疾病预后
Primary liver cancer
Cirrhosis
Ulinastatin
Partial hepatectomy
Liver function
Inflammatory factor
Immune function
Prognosis of disease
