内毒素、TNF-α与IL-6与重型乙型肝炎关系研究

发布时间：2018-04-13 15:48

本文选题：重型肝炎 + 内毒素　；参考：《河北联合大学》2014年硕士论文

【摘要】：目的检测重型乙型肝炎患者血清中内毒素（LPS）、肿瘤坏死因子（TNF-α）和白细胞介素-6（IL-6）水平，并同慢性乙型肝炎患者与正常对照组比较，探讨它们与乙型肝炎重型化关系，为慢性肝炎临床治疗和预后判断提供理论和临床依据。方法病例取自唐山市传染病院2012年6月至2013年10月住院患者和健康体检者共120例，其中慢性重型乙型肝炎患者40例（男：34例，女：6例），年龄：22~44岁（平均年龄：33.4±12.0岁）、慢性乙型肝炎患者40例（男：33例，女：7例），年龄：26~48岁（平均年龄：36.1±8.3岁）和40例非乙型肝炎患者(健康体检者)为正常对照组，，（男：35例，女：5例），年龄：25~46岁（平均年龄：35.3±10.2岁）。入院后未进行治疗前抽取清晨空腹静脉血，检测血清总胆红素（TBil）和谷丙转氨酶（ALT）；并分别用鲎三肽基质显色法和酶联免疫吸附测定法检测各组LPS、TNF-α及IL-6的含量。应用SPSS13.0版统计软件处理数据。计量资料以均数±标准差（x s）表示，采用方差分析。内毒素与细胞因子间及与患者预后之间关系采用Pearson积矩相关分析。结果1乙型肝炎组患者血清中ALT和TBil含量明显高于健康对照组（P0.05）；慢性重型乙型肝炎组患者血清中ALT和TBil含量高于慢性乙型肝炎组（P0.05）；2乙型肝炎组患者血清中LPS，TNF-α及IL-6的含量较健康对照组明显增高（P0.05），慢性重型乙型肝炎组患者血清中LPS，TNF-α及IL-6的含量明显高于慢性乙型肝炎组患者（P0.05）；3慢性重型乙型肝炎患者血清中ALT与LPS，TNF-α和IL-6相比无明显相关性；4慢性重型乙型肝炎患者血清中TNF-α含量随着LPS升高而升高，两者间有相关性（rLPS-TNF-α=0.358P0.005），慢性重型乙型肝炎患者血清中IL-6含量随着LPS升高而升高，两者呈正相关（rLPS-IL-6=0.344P0.005）；5LPS，TNF-α和IL-6的水平与慢性重型乙型肝炎患者预后存在显著的相关性。结论慢性重型乙型肝炎患者肝功能明显受损；在慢性乙型肝炎重型化过程中，内毒素水平增高可能是其重要诱因之一，内毒素介导TNF-α及IL-6升高可能是肝细胞损伤机制之一；内毒素和TNF-α及IL-6可以作为慢性重型乙型肝炎预后判断的间接指标。
[Abstract]:Objective to detect the serum endotoxin in patients with severe hepatitis B (LPS), tumor necrosis factor alpha (TNF- alpha) and interleukin -6 (IL-6) level, compared with the normal control group and chronic hepatitis B patients, and explore their relationship with hepatitis B, and provide theoretical and clinical basis for judging the clinical treatment of chronic hepatitis and the prognosis of the patients.
Methods patients from June 2012 to October 2013 in Tangshan City infectious hospital patients and healthy subjects were 120 cases, including 40 cases of chronic severe hepatitis B patients (male: 34 cases, female: 6 cases), age: 22~44 years old (average age: 33.4 + 12 years), 40 cases of chronic hepatitis B patients (male: 33 cases, female: 7 cases), age: 26~48 years old (average age: 36.1 + 8.3 years) and 40 cases of non hepatitis B patients (healthy subjects) as normal control group (male: 35 cases, female: 5 cases), age: 25~46 years old (average age: 35.3 + 10.2 years). After the hospital had no treatment before the morning fasting venous blood, serum total bilirubin (TBil) and alanine aminotransferase (ALT); and three respectively by Limulus peptide chromogenic substrate method and ELISA method to detect the content of LPS, TNF- alpha and IL-6. The application of SPSS13.0 statistical software data processing of measurement data. Mean standard deviation (x S) indicated the use of variance analysis. The relationship between endotoxin and cytokine and the prognosis of patients was analyzed by Pearson moment correlation analysis.
The results of ALT and TBil in 1 hepatitis B patients were significantly higher than those in healthy control group (P0.05); ALT and TBil in the sera of patients with chronic severe hepatitis B is higher than that of chronic hepatitis B (P0.05); the 2 group of hepatitis B in the serum of patients with LPS, the content of TNF- alpha and IL-6 higher than those in healthy control group (P0.05), sera of patients of chronic severe hepatitis B in LPS, the content of TNF- alpha and IL-6 was significantly higher than that in chronic hepatitis B patients (P0.05 group); 3 patients with chronic severe hepatitis B in ALT and LPS, TNF- and IL-6 showed no significant correlation between alpha TNF- alpha 4; the content of serum in patients with chronic severe hepatitis B. With the increase of LPS, and there is a correlation between (rLPS-TNF- alpha =0.358P0.005), the content of IL-6 in serum of patients with severe chronic hepatitis B and increased with the increase of LPS, there is a positive correlation between them (rLPS-IL-6=0.344P0.005); 5LPS, TNF- and IL-6 There is a significant correlation between the level and the prognosis of chronic severe hepatitis B patients.
Conclusion the liver function of patients with chronic severe hepatitis B was significantly impaired; in chronic hepatitis B during endotoxin levels may be one of the important cause of endotoxin mediated TNF- alpha and IL-6 increase may be one of the mechanisms of injury of liver cells; indirect index of endotoxin and TNF- alpha and IL-6 can be used to judge the prognosis of chronic severe hepatitis B.

【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62

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