血清IL-1α与IL-10用于重度慢性乙型肝炎患者接受糖皮质激素治疗的预后价值研究  

Prognostic value of serum levels of IL-1α and IL-10 for the glucocorticoids treatment in patients with severe chronic hepatitis B

作　　者：李锐锋[1,2] 段军[2] 江宗群[2] 赵博[1] 谢桂娟[1] 陈晴[1] 张辉艳[1] 张绪清[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,重庆400038 [2]解放军第477医院感染科

出　　处：《胃肠病学和肝病学杂志》2016年第5期490-494,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金面上项目(81270525);第三军医大学临床科研重大专项(2012XLC05)

摘　　要：目的探讨血清白细胞介素-1α(interleukin-1α,IL-1α)及IL-10用于重度慢性乙型肝炎(chronic hepatitis B,CHB)患者接受短期糖皮质激素(glucocorticoids,GCs)治疗的预后价值。方法回顾性纳入2006年5月-2013年6月在第三军医大学西南医院感染科住院的重度CHB患者95例,按照是否接受GCs治疗分为GC组(n=43)与非GCs组(n=52),同时纳入慢性HBV携带者(n=20)及健康体检者(n=20)作为对照。GCs治疗使用地塞米松(10 mg/d,静脉推注,连用5 d)。住院时采集患者一般情况、实验室指标,检测血清IL-1α及IL-10,分析指标之间的相关性。对GC组患者进行随访,观察预后情况。结果重度CHB患者IL-1α及IL-10均显著高于慢性HBV携带者及健康人群。重度CHB患者MELD评分与IL-1α呈正相关(r=0.397,P<0.001),与IL-10呈负相关(r=-0.387,P<0.001)。GC组180 d总体生存率(overall survival,OS)高于非GC组(83.7%vs 71.2%,P=0.025)。GC组中高IL-1α水平患者180 d OS低于低IL-1α水平患者(79.2%vs 89.5%,P=0.034),高IL-10水平患者180 d OS显著高于低IL-10水平患者(95.5%vs 71.4%,P=0.039)。血清IL-1α及IL-10分别用于预测GC组患者6个月病死率的AUC为0.738及0.746,IL-1α联合IL-10预测的AUC为0.849。结论 GCs治疗可改善重度CHB患者预后,血清IL-1α及IL-10可作为重度CHB患者接受GCs治疗的有效无创预后指标。Objective To investigate the prognostic value of interleukin-1α （IL-1α） and IL-10 for the glucocorticolds （GCs） treatment in patients with severe chronic hepatitis B （CHB）. Methods A total of 95 patients with severe CHB in the Institute of Infectious Diseases in Southwest Hospital from May. 2006 to Jun. 2013 were enrolled. According to the treatment with GCs, the patients were divided into GC group （n = 43） and non-GC group （ n = 52） , and 20 chro- nic HBV carriers and 20 healthy people were as controls. The demographic, laboratory parameters, IL-1α and IL-10 levels were recorded, and the correlations between IL-1 α （or IL-10） and parameters were analyzed. The patients in GC group were followed up. Results IL-1α and IL-10 in GC group were significantly higher than those in chronic HBV carriers and healthy people. MELD score in patients with severe CHB was significantly correlated with IL-la positively （ r = 0. 397, P 〈 0. 001 ） or IL-10 negatively （ r = - 0. 387, P 〈 0. 001 ）. The 180 d overall survival （OS） in GC group was higher than that in non-GC group （83.7% vs 71.2% , IL-1α was lower than that with low IL-1α （79.2% vs 89.5 was significantly higher than low IL-10 （95.5% vs 71.4% P =0.025）. In GC group, 180 d OS in patients with high % , P =0.034） , and 180 d OS in patients with high IL-10 , P =0. 039）. AUC of IL-1α used to predict the 6 months mortality of patients in GC group was 0. 738, and the AUC of IL-10 was 0. 746. Furthermore, AUC of IL-1α combined with IL-10 used to predict the 6 months mortality was 0. 849. Conclusion GCs therapy can improve the prognosis of patients with severe CHB, and serum IL-1α and IL-10 can be used as an effective non-invasive prognostic indicator of GCs treatment in patients with severe CHB.

关 键 词：慢性乙型肝炎 糖皮质激素 白细胞介素-1Α 白细胞介素-10 终末期肝病模型 

分 类 号：R392.3[医药卫生—免疫学] R512.62[医药卫生—基础医学]