N-Acetylcysteine for liver and kidney function protection during the perioperative period of hepatectomy in the context of liver cirrhosis
WANG Zhi-gang, YAN Rui-long, YUAN Cui-hua
2024, 29(7):
808-839.
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Objective To investigate the protective effect of N-acetylcysteine (NAC) combined with ulinastatin on liver and kidney function in cirrhosis patients who undergone hepatectomy during perioperative period. Methods A total of 74 patients with cirrhosis who underwent elective partial hepatectomy were selected from January 2021 to March 2023, and were randomly divided into observation group and control group (37 cases each). Control group was treated with ulinastatin injection during perioperative period, and observation group was treated with ulinastatin combined with NAC injection. The changes of inflammatory oxidative stress, liver and kidney function and safety indexes were observed in the two groups. Results The levels of IL-1β at 3 and 7 days after operation in the observation group were 43.59±6.17 μg/L and 35.94±5.10 μg/L, respectively, and TNF-α levles were 26.53±3.91 ng/L and 20.48±3.27 ng/L, respectively. These were significantly lower than the control group's IL-1β levels of 47.92±6.58 μg/L and 39.71±5.76 μg/L, and TNF-α levles of 29.86±4.35 ng/L and 25.61±3.80 ng/L (t=6.524, 6.249, 6.725, 7.314, all P<0.05). At 3 and 7 days post-operation, MDA levels in the observation group were 12.08±2.15 μmol/L and 8.14±1.52 μmol/L, which were lower than the control group's 14.35±2.39 μmol/L and 9.82±1.76 μmol/L. SOD levels in the observation group were 55.04±5.81 U/L and 63.27±6.24 U/L, significantly higher than 52.15±5.46 U/L and 58.79±6.43 U/L in control group (t=6.592, 6.823, 6.739, 6.541, all P<0.05). The levels of ALT, γ-GT, TBil, TBA, SF, RBP and CysC in the observation group were 80.59±6.51 U/L, 59.34±5.62 U/L, 90.15±6.83 U/L, 64.28±5.74 U/L, 21.06±2.37 μmol/L, 15.79±2.08 μmol/L, 11.54±1.90 μmol/L, 9.64±1.57 μmol/L, 385.92±31.70 ng/mL, 351.48±27.09 ng/mL, respectively, all significantly lower than 86.73±7.04 U/L, 67.19±6.47 U/L, 98.74±7.49 U/L, 70.26±6.15 U/L, 22.79±2.51 μmol/L, 17.84±2.35 μmol/L, 12.76±2.02 μmol/L, 10.79±183 μmol/L, 407.59±34.28 ng/mL, 369.85±30.63 ng/mL in the control group. The ALB levels in the observation group were 30.78±2.18 g/L and 32.51±2.46 g/L, which were significantly higher than those in the control group (29.16±2.04 g/L, 30.76±2.17 g/L; t=6.853, 7.128, 6.784, 6.573, 5.487, 6.284, 5.185, 5.384, 6.719, 5.826, 5.438, 5.629, all P<0.05). The levels of RBP and CysC in the observation group were 62.28±5.39 mg/L, 52.06±4.92 mg/L, 2.60±0.52 mg/L, 2.42±0.43 mg/L. It was lower than that of the control group (68.17±5.74 mg/L, 57.48±5.26 mg/L, 2.81±0.59 mg/L, 2.64±0.48 mg/L), with statistically significant difference (t=6.819, 6.793, 6.836, 6.287, all P<0.05). The incidence rates of postoperative infection, HE, PHLF and AKI in the observation group were 2.70%, 2.70%, 0%, and 0%, respectively, significantly lower than those in the control group (8.11%, 10.81%, 2.70%, and 5.41%; χ2=3.284, 3.827, 3.496, 3.608, all P<0.05). Conclusion NAC combined with ulinastatin can inhibit perioperative inflammatory response and oxidative stress in cirrhotic patients who undergone hepatectomy. NAC plays a protective role for liver and kidney function.
