HMGB1及中国评分系统在乙型肝炎肝衰竭中的预警作用

发布时间：2018-02-25 22:33

  本文关键词： HMGB1 乙型肝炎 肝衰竭 预后预测 中国评分系统　出处：《新乡医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的乙型肝炎病毒感染是全球性的公共卫生问题,严重威胁人类生命健康。全球约有3.5亿人是慢性感染者,全球每年约有70万人死于HBV相关的终末期肝病,如肝衰竭、失代偿期肝硬化等。终末期肝病的死亡率高达70%以上,肝衰竭以慢性肝衰竭急性发作占多数,此类患者病情发展迅速,在患者住院早期需临床医生对病情做出及时判断,采取合理治疗方案。积极探索肝衰竭新的预警指标和早期诊断方法是肝病工作者关注的重点课题之一。研究表明,HMGB1作为晚期炎性因子,参与脓毒症和SIRS的病理生理过程,维持和延长炎症反应。HBV相关的慢加急性肝衰竭时,血循环中的DC富集到肝脏,并被激活后,抗原递呈作用明显加强,促使机体的免疫反应进入激进状态,提示HMGBl可能与肝衰竭的发病有相关性。如何准确评判肝衰竭患者的预后是值得探讨的临床课题。 方法1.对32例乙型重症肝炎患者、22例慢乙肝患者、10例急性乙肝患者及16例健康体检者于肘静脉处抽取静脉血,于抽血后30分钟内置离心机离心分离出血清分装至1.5ml的离心管中置于-80℃冰箱保存待用ELISA检测,分析HMGB1表达与患者肝功能生物化学指标的相关性。2.根据我国乙肝肝衰竭患者特点,通过七个临床指标组成的中国评分系统对70例肝衰竭患者预后进行评价。应用SPSS17.0统计软件包进行数据处理。计量资料用均数±标准差表示,两组均数间比较采用t检验,率的比较采用χ2检验。同时绘制受试者工作特征(ROC)曲线,用c-统计值(即ROC曲线下面积)评价中国评分对乙型病毒性肝炎肝衰竭患者预后的预测准确性。以期制定一套不同于欧美国家的评分标准。 结果1、患者和正常人血清中均有HMGB1表达,其中重症肝炎(肝衰竭)组、慢乙肝组、急性乙肝组HMGB1表达水平均高于正常人组；组间比较显示：重症肝炎组与慢乙肝初治,重症肝炎组与急性乙肝组,慢乙肝初治组与急性乙肝组,慢性乙肝组与正常人组,急性乙肝—正常人组均无统计学意义(p0.05),其中重症肝炎组与正常人组组间差异有统计学(p0.00)。 2、中国评分系统的分值越高,肝衰竭患者的病死率越高。ROC曲线对中国评分系统判断肝衰竭患者预后的ROC曲线下面积0.877,用该模型判断70例重型肝炎患者预后是可信的。 结论本实验通过探讨HMGB1在肝衰竭患者中的表达水平及其临床意义,为临床诊断提供新的依据；针对乙型肝炎肝衰竭的特殊性,通过七个临床指标组成的中国评分系统对我国乙肝肝衰竭患者的预后评价是可行的。综上所述,HMGB1和中国评分系统对乙型肝炎引起的肝衰竭患者预后预测是有指导意义的。
[Abstract]:Objective Hepatitis B virus infection is a global public health problem, which is a serious threat to human life and health. About 350 million people in the world are chronically infected, and every year about 700,000 people die of HBV related end-stage liver disease, such as liver failure. Decompensated liver cirrhosis and so on. The death rate of end-stage liver disease is as high as more than 70%. The majority of liver failure is acute attack of chronic liver failure. This kind of patient's condition develops rapidly. In the early stage of hospitalization, clinicians are required to make timely judgement on the condition of the patient. It is one of the most important topics for liver disease workers to adopt reasonable treatment plan and actively explore new early warning index and early diagnosis method of liver failure. The study shows that HMGB1, as a late inflammatory factor, is involved in the pathophysiological process of sepsis and SIRS. When chronic and acute hepatic failure associated with HBV was maintained and prolonged, DC in the blood circulation was enriched into the liver, and after activation, the antigen presentation was significantly enhanced, and the immune response of the body entered into a radical state. It is suggested that HMGBl may be associated with the pathogenesis of liver failure, and how to accurately evaluate the prognosis of patients with liver failure is a clinical topic worthy of discussion. Methods 1. Venous blood was drawn from the cubital vein of 32 patients with severe hepatitis B, 22 patients with chronic hepatitis B and 10 patients with acute hepatitis B and 16 healthy controls. After 30 minutes of blood sampling, centrifuge centrifuge was used to separate the serum and put it into 1.5ml centrifuge tube. The serum was stored in the refrigerator at -80 鈩，

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