CD40表达及其配体血清水平的动态变化对慢加急性肝衰竭预后的评估价值  

Prognosticating value of altered serum-soluble CD40L level and CD40 expression on monocytes in acute-on-chronic liver failure

作　　者：郑玉宝[1] 谢仕斌[1] 谢冬英[1] 林炳亮[1] 赵志新[1] 崇雨田[1] 高志良[1] 

机构地区：[1]中山大学附属第三医院感染科,广州市510630

出　　处：《中华实验和临床感染病杂志（电子版）》2010年第1期12-15,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：广东省科技计划项目(2006B36005004);"十一五"科技重大专项分题(2008ZX10202)

摘　　要：目的研究慢加急性肝衰竭(ACLF)不同病程CD40L血清水平以及外周血单个核细胞(PBMCs)CD40表达的动态变化,旨在探讨CD40L血清水平及单核细胞上CD40的表达对慢加急性肝衰竭病情的预测价值。方法采用流式细胞术(FACS)分别对慢加急性肝衰竭早期(ACLF-E)和晚期(ACLF-L)组(25例)、慢性乙型肝炎(CHB)组(28例)、肝炎肝硬化(LC)组(13例)及健康对照(HC)组(20例)的PBMCs上CD40的表达进行检测,同时血清中可溶CD40L(即sCD154)的水平采用酶联免疫吸附试验(ELISA)测定。结果与HC组比较,CHB组、LC组、ACLF-E组及ACLF-L组PBMCs的CD40表达水平呈逐渐增加趋势,ACLF-E组增加尤其明显;ACLF-E组中血清可溶性CD40L浓度也明显高于HC组、CHB组、LC组及ACLF-L组;ACLF死亡组病程早期与晚期CD40及CD40L表达的水平均高于存活组。结论血清CD40L浓度及CD40表达与ACLF病情及预后密切相关,血清CD40L水平及PBMC上CD40表达水平可以作为ACLF病情评估和预后判断的重要标志之一。Objective To investigate the altered states of CD40 expression on monocytes and serum-soluble CD40L levels in different stages of patients with acute-on-chronic liver failure （ACLF） and their clinical prognosticating value in patients with ACLF.Methods Patients with ACLF （n=25）,chronic hepatitis B（CHB） （n=28）,liver cirrhosis （LC） （n=13） and healthy controls （HC） （n=20） were studied and CD40 expression on monocytes were detected by fluorescence activated cell sorting （FACS）.Serum-soluble CD40L was measured by enzyme-linked immunosorbent assay （ELISA）.Results Compared with healthy controls,the levels of CD40 expression on monocytes in patients with chronic hepatitis B,liver cirrhosis and ACLF were gradually increased,especially in the early stage of ACLF.The concentration of serum-soluble CD40L level in ACLF early-stage was significantly higher than HC,CHB and LC and ACLF late-stage.CD40 expression and serum-soluble CD40L level in dead patients were significantly higher than those survived in early and late stages of ACLF.Conclusions An altered level of serumr-soluble CD40L and CD40 expression might be closely related to the severity of ACLF and may be valuable prognostic markers for survival in patients with ACLF.

关 键 词：慢加急性肝衰竭 血清CD40L水平 CD40表达 预后评估 

分 类 号：R575.3[医药卫生—消化系统]