乙型肝炎相关慢加急性肝衰竭患者血清白细胞介素1受体拮抗剂与疾病严重程度的关系

发布时间：2019-03-28 14:38

【摘要】：目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者外周血白细胞介素(IL)1受体拮抗剂(IL-1Ra)与患者疾病严重程度的关系。方法选取福州市传染病医院2013年10月-2015年1月就诊的31例HBV-ACLF患者为研究对象,另选取同期28例急性乙型肝炎(AHB)和30例慢性乙型肝炎(CHB)患者作为对照。用Q-Plex法检测外周血IL-1Ra、IL-1β、IL-6、IL-4、IL-10、肿瘤坏死因子(TNF)α、干扰素(IFN)γ等细胞因子浓度,并检测各组肝功能、凝血功能等,将血清IL-1Ra等细胞因子浓度与患者肝功能、MELD评分及HBV DNA等进行相关分析。多组间比较采用Kruskal-wallis H检验,进一步两两比较采用Mann-Whitney U检验;计数资料采用χ2检验;相关分析采用Spearman秩相关。结果 IL-1Ra、IL-1Ra/IL-1β在3组之间的差异均有统计学意义(P值均0.05),其中HBV-ACLF组IL-1Ra水平[186.46(162.68~512.90)pg/ml]显著高于CHB组[70.47(47.07~92.47)pg/ml]和AHB组[143.69(117.75~208.54)pg/ml],差异均有统计学意义(Z=6.300,P0.001;Z=2.505,P=0.012);而HBV-ACLF患者IL-1Ra与IL-1β比值[2.92(2.20~4.74)]较AHB组[4.54(2.75~6.05)]低,但较CHB患者[2.49(1.50~2.50)]高,差异均有统计学意义(Z=1.966,P=0.048;Z=2.682,P0.001)。HBV-ACLF组IL-1β、IL-6、TNFα水平显著高于其他2组(P值均0.01)。血清IL-1Ra与TBil、MELD评分均呈负相关(r值分别为-0.506、-0.818,P值均0.01),与凝血酶原活动度(PTA)呈正相关(r=0.475,P=0.007)。结论 IL-1Ra与反映HBV-ACLF严重程度的指标TBil、MELD评分呈负相关,与PTA呈正相关,IL-1ra在HBV-ACLF发病过程中可能起重要作用。
[Abstract]:Objective to investigate the relationship between peripheral blood interleukin (IL) 1 receptor antagonist (IL-1Ra) and the severity of hepatitis B associated chronic and acute hepatic failure (HBV-ACLF). Methods 31 patients with HBV-ACLF from October 2013 to January 2015 in Fuzhou Infectious Diseases Hospital were selected as study subjects, 28 patients with acute hepatitis B (AHB) and 30 patients with chronic hepatitis B (CHB) in the same period were selected as controls. The levels of cytokines such as IL-1Ra,IL-1 尾, IL-6,IL-4,IL-10, tumor necrosis factor (TNF) 伪 and interferon (IFN) 纬 in peripheral blood were detected by Q-Plex method, and the liver function and coagulation function of each group were detected. Serum levels of cytokines such as IL-1Ra were correlated with liver function, MELD score and HBV DNA. Kruskal-wallis H test was used for multigroup comparison, Mann-Whitney U test was used for further pairwise comparison, 蠂 2 test was used for counting data, and Spearman rank correlation was used for correlation analysis. Results the difference of IL-1Ra,IL-1Ra/IL-1 尾 among the three groups was statistically significant (P < 0.05). The level of IL-1Ra in HBV-ACLF group [186.46 (162.68 / 512.90) pg/ml] was significantly higher than that in CHB group [70.47 (47.07 渭 92.47) pg/ml] and AHB group [143.69 (117.75 / 208.54) pg/ml]. The difference was statistically significant (Z = 6.300, P < 0.001); Za 2.505, P0. 012 (P < 0. 012); The ratio of IL-1Ra to IL-1 尾 in HBV-ACLF [2.92 (2.20? 4.74)] was lower than that in AHB [4.54 (2.75? 6.05)], but higher than that in CHB [2.49 (1.50? 2.50)]. P0. 048; The levels of IL-1 尾 and IL-6,TNF 伪 in HBV-ACLF group were significantly higher than those in the other two groups (P < 0.01). Serum IL-1Ra was negatively correlated with TBil,MELD score (r =-0.506, P = 0.818, P = 0.01), and positively correlated with prothrombin activity (PTA) (r = 0.475, P = 0.007). Conclusion IL-1Ra is negatively correlated with TBil,MELD score, which reflects the severity of HBV-ACLF, and positively correlated with PTA. IL-1ra may play an important role in the pathogenesis of HBV-ACLF.
【作者单位】：福州市传染病医院福建医科大学孟超肝胆医院肝病科;福州市传染病医院福建医科大学孟超肝胆医院麻醉科;
【基金】：福州市科技计划项目(2013-S-125-3) 福建省卫生与计划生育委员会青年科研基金项目(2013-2-82) 福建省青年教师教育项目(JB13126) 福建省卫计委青年科研基金项目(2013-2-81)
【分类号】：R512.62;R575.3

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