肝功能衰竭患者治疗中外周血单个核细胞端粒酶反转录酶mRNA动态变化及其意义  

Dynamic variation of human telomerase reverse transcriptase mRNA in peripheral blood mononuclear cells during treatment of patients with liver failure and its significance

作　　者：王海燕[1] 朱传武[1] 方焕[2] 钱峰[1] 李明[1] 罗湘蓉[1] 张雪华[1] 朱翔[1] 沈秀娟[1] 

机构地区：[1]江苏省苏州市第五人民医院肝病科,215007 [2]蚌埠医学院第二附属医院感染科

出　　处：《中华传染病杂志》2014年第8期464-469,共6页Chinese Journal of Infectious Diseases

基　　金：苏州市科学技术局项目（SYS201058）

摘　　要：目的 探讨肝功能衰竭患者在治疗过程中PBMC端粒酶反转录酶（hTERT） mRNA表达的动态变化及其对预后的评估价值.方法 苏州市第五人民医院肝病科2010年11月至2012年12月间收治的肝功能衰竭患者85例,健康志愿者10名为对照组.实时定量反转录PCR检测肝功能衰竭患者治疗前及治疗后1、2、3和4周PBMC hTERT mRNA的表达水平,根据随访3个月时的生存和死亡情况,动态分析患者PBMC hTERT mRNA的变化,受试者工作特征曲线下面积（AUC）分析PBMChTERT mRNA对肝功能衰竭预后的评估价值.均数的比较用独立样本t检验,计数资料的比较用x2检验,中位数的比较用Mann-Whitney U检验,患者临床因素对预后的影响用Logistic回归分析.结果 85例肝功能衰竭患者中具有完整研究资料的76例被纳入最终分析,其中生存52例,死亡24例.生存组PBMC hTERT mRNA的相对表达量随治疗时间的延长而增加,生存组在治疗后2、3和4周时均高于死亡组,差异均有统计学意义（U值分别为299.0、16.0和17.5,均P＜0.01）.治疗后2、3和4周,患者PBMC hTERT mRNA的AUC分别为0.760、0.987和0.986（95％CI分别为0.652～0.869、0.965～1.009和0.958～1.014）.且从治疗后2周开始,患者PBMC hTERT mRNA表达即对生存具有显著评估价值（P＜0.01）.慢加急性肝功能衰竭患者PBMC hTERT mRNA表达水平在治疗后各观察点上均显著高于慢性肝功能衰竭患者（U值分别为414.0、436.5、377.0和385.0,均P＜0.05）.慢加急性肝功能衰竭患者治疗后2、3和4周时生存组PBMC hTERT mRNA相对表达量均高于死亡组,差异均有统计学意义（U值分别为56.0、6.0和4.5,均P＜0.05）;慢性肝功能衰竭患者治疗后2、3和4周时生存组PBMC hTERT mRNA相对表达量亦高于死亡组,差异均有统计学意义（U值分别为31.0、0和0,均P＜0.01）.结论 肝功能衰竭的临床类型及预后与患者PBMC hTERT mRNA的表达密切相关,动态观察其水平的变化有助于评Objective To investigate the dynamic change and its prognostic value of human telomerase reverse transcriptase （hTERT） mRNA expression in peripheral blood mononuclear cells （PBMC） during treatment of patients with liver failure.Methods Eighty-five patients with liver failure,who were hospitalized in Department of Hepatology,the Fifth People＇s Hospital of Suzhou,between November 2010 and December 2012,were enrolled,and ten healthy volunteers were enrolled as control.The levels of hTERT mRNA expressed by PBMC were detected by relative quantitative real-time polymerase chain reaction （RT-PCR） assay using the samples taken before treatment and at week 1,2,3 and 4 after treatment.The patients were divided into survival and non-survival groups according to the 3-month mortality after treatment.The dynamic variations of PBMC hTERT mRNA at different time points were analyzed,and their prognostic values were assessed by the area under the receiver operating characteristic curve （AUC）.The means were analyzed by independent-samples t test,the rates by Pearson chi-square test,and the medians by nonparametric Mann-Whitney U test.Logistic regression was used to analyze the clinical factors on prognosis.Results Seventy-six patients with complete data among 85 patients were included in the final analysis.Of them,52 survived and 24 died.During the observation,the levels of PBMC hTERT mRNA increased with treatment duration in survival group,but those were persistently lower in non-survival group.The median levels in survival group were all significantly higher than those in non-survival group after 2,3 and 4 weeks of treatment （U value was 299.0,16.0 and 17.5,respectively; all P〈0.01）,and the AUC were 0.760,0.987 and 0.986,respectively （95% confidence intervals were 0.652-0.869,0.965-1.009 and 0.958-1.014,respectively）.The expression levels of hTERT mRNA from week 2 of treatment showed significantly prognostic value （P〈 0.01）.Further analyses showed that the median level in patients with acute-on-

关 键 词：肝功能衰竭 外周血单个核细胞 人端粒酶逆转录酶 RNA 信使 动态变化 预后 

分 类 号：R575.3[医药卫生—消化系统]