Roth G A, Faybik P, Hetz H, Hacker S, Ankersmit H J, Bacher A, Thalhammer T, Krenn C G
Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
Dig Liver Dis. 2009 Jun;41(6):417-23. doi: 10.1016/j.dld.2008.09.021. Epub 2008 Nov 18.
The pro-inflammatory cytokine IL-18 and its activator Caspase-1 are involved in acute liver failure and acute-on-chronic-liver-failure. In acute liver failure and acute-on-chronic-liver-failure, the MARS system has been used to support liver function. Enhancement of IL-18, as seen in other extracorporeal-support systems like hemodialysis might thus have mitigated beneficial effects of the MARS system in acute hepatic failure.
We measured serum concentrations of IL-18 and Caspase-1 in 10 patients with acute liver failure and 10 patients suffering from acute-on-chronic-liver-failure, who were all treated with MARS. Thirteen patients suffering from chronic hepatic failure and 15 healthy individuals served as controls. Data are given as mean with 95% CI.
Baseline IL-18 serum concentrations were significantly increased in acute liver failure and acute-on-chronic-liver-failure patients as compared to chronic hepatic failure (P=0.0039 and P=0.0011, respectively) and controls (P=0.0028 and P=0.0014, respectively). Caspase-1 serum concentrations were as well significantly elevated in the acute liver failure and acute-on-chronic-liver-failure groups as compared to chronic hepatic failure patients (P=0.0039 and P=0.0232, respectively) and controls P<0.0001 and P<0.0007, respectively). IL-18 and Caspase-1 did not change significantly during MARS treatment in acute liver failure and acute-on-chronic-liver-failure patients.
MARS had no effect on IL-18 and Caspase-1 serum concentrations in acute liver failure and acute-on-chronic-liver-failure, providing no evidence of harmful effects by the increase of these potentially hepatocidal cytokines.
促炎细胞因子白细胞介素 - 18（IL - 18）及其激活剂半胱天冬酶 - 1参与急性肝衰竭和慢加急性肝衰竭。在急性肝衰竭和慢加急性肝衰竭中，分子吸附再循环系统（MARS）已被用于支持肝功能。正如在血液透析等其他体外支持系统中所见，IL - 18的增强可能会减轻MARS系统在急性肝衰竭中的有益作用。
我们检测了10例急性肝衰竭患者和10例慢加急性肝衰竭患者血清中IL - 18和半胱天冬酶 - 1的浓度，这些患者均接受了MARS治疗。13例慢性肝衰竭患者和15名健康个体作为对照。数据以平均值及95%置信区间表示。
与慢性肝衰竭患者（分别为P = 0.0039和P = 0.0011）及对照组（分别为P = 0.0028和P = 0.0014）相比，急性肝衰竭和慢加急性肝衰竭患者的基线IL - 18血清浓度显著升高。与慢性肝衰竭患者（分别为P = 0.0039和P = 0.0232）及对照组（分别为P < 0.0001和P < 0.0007）相比，急性肝衰竭和慢加急性肝衰竭组的半胱天冬酶 - 1血清浓度也显著升高。在急性肝衰竭和慢加急性肝衰竭患者的MARS治疗期间，IL - 18和半胱天冬酶 - 1没有显著变化。
MARS对急性肝衰竭和慢加急性肝衰竭患者的IL - 18和半胱天冬酶 - 1血清浓度没有影响，没有证据表明这些潜在的肝细胞杀伤性细胞因子增加会产生有害影响。
