Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan.
World J Surg. 2012 May;36(5):1122-1127. doi: 10.1007/s00268-012-1501-8.
The effects of sivelestat on endotoxin-induced lung injury, postperfusion lung injury, and ischemia-reperfusion are known, yet the benefits of sivelestat during liver surgery have yet to be elucidated. The aim of the present study was to assess the effects of sivelestat, with a focus on postoperative chemical data, in hepatectomized patients.
A prospective clinical study was conducted in 50 patients undergoing hepatic resection. Patients were randomly assigned to receive Elaspol, sivelestat (ELP group, n = 25) or placebo (control group, n = 25). Perioperative blood chemistry values in both groups, including high-mobility group box 1 (HMGB1) and interleukin (IL)-6, were monitored.
The HMGB1 levels increased immediately after the operation (from the intraoperative period to the second postoperative day [POD]) in the control group. Compared to the control group, the levels of HMGB1 in the ELP group were significantly suppressed by the perioperative administration of sivelestat. At POD 1, the levels of IL-6 in the ELP group decreased more rapidly than those before the operation compared to the control group.
A human clinical study demonstrated the effect of polymorphonuclear leukocyte elastase inhibitor on the earliest markers of liver injury. The present study showed that patients who received sivelestat had reduced release of HMGB1, and that IL-6 levels decreased more rapidly in patients treated with sivelestat than in those who received the placebo. The most appropriate dose, timing, and duration of sivelestat in humans remain unclear; however, it may have therapeutic potential for various liver injuries.
西维来司他对内毒素诱导的肺损伤、再灌注后肺损伤和缺血再灌注的作用已为人所知，但它在肝外科手术中的益处尚未阐明。本研究旨在评估西维来司他对肝切除患者的影响，重点是术后生化数据。
对 50 例接受肝切除术的患者进行了前瞻性临床研究。患者被随机分为接受 Elaspol（西维来司他，ELP 组，n = 25）或安慰剂（对照组，n = 25）的治疗。监测两组围手术期的血液生化值，包括高迁移率族蛋白 B1（HMGB1）和白细胞介素（IL）-6。
对照组患者 HMGB1 水平在手术后立即升高（从手术期间到术后第 2 天[POD]）。与对照组相比，ELP 组围手术期给予西维来司他可显著抑制 HMGB1 水平。与对照组相比，ELP 组在 POD1 时 IL-6 水平下降更快，且低于术前水平。
一项人体临床研究证明了多形核白细胞弹性蛋白酶抑制剂对肝损伤最早标志物的作用。本研究表明，接受西维来司他治疗的患者 HMGB1 释放减少，且接受西维来司他治疗的患者 IL-6 水平下降速度快于接受安慰剂的患者。西维来司他在人体内的最佳剂量、时机和持续时间尚不清楚；然而，它可能对各种肝损伤具有治疗潜力。
