乙型肝炎相关慢加急性肝衰竭患者血清白细胞介素1受体拮抗剂与疾病严重程度的关系  

Correlation between serum interleukin-1 receptor antagonist and disease severity in patients with HBV-related liver failure

作　　者：赖静兰[1] 刘玉明[2] 林春[1] 孙芳[1] 周锐[1] 林勇[1] 林元豹 

机构地区：[1]福州市传染病医院福建医科大学孟超肝胆医院肝病科 [2]福州市传染病医院福建医科大学孟超肝胆医院麻醉科,福州350025

出　　处：《临床肝胆病杂志》2016年第5期890-893,共4页Journal of Clinical Hepatology

基　　金：福州市科技计划项目(2013-S-125-3);福建省卫生与计划生育委员会青年科研基金项目(2013-2-82);福建省青年教师教育项目(JB13126);福建省卫计委青年科研基金项目(2013-2-81)

摘　　要：目的探讨乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）患者外周血白细胞介素（IL）1受体拮抗剂（IL-1Ra）与患者疾病严重程度的关系。方法选取福州市传染病医院2013年10月-2015年1月就诊的31例HBV-ACLF患者为研究对象,另选取同期28例急性乙型肝炎（AHB）和30例慢性乙型肝炎（CHB）患者作为对照。用Q-Plex法检测外周血IL-1Ra、IL-1β、IL-6、IL-4、IL-10、肿瘤坏死因子（TNF）α、干扰素（IFN）γ等细胞因子浓度,并检测各组肝功能、凝血功能等,将血清IL-1Ra等细胞因子浓度与患者肝功能、MELD评分及HBV DNA等进行相关分析。多组间比较采用Kruskal-wallis H检验,进一步两两比较采用Mann-Whitney U检验;计数资料采用χ2检验;相关分析采用Spearman秩相关。结果 IL-1Ra、IL-1Ra/IL-1β在3组之间的差异均有统计学意义（P值均〈0.05）,其中HBV-ACLF组IL-1Ra水平[186.46（162.68-512.90）pg/ml]显著高于CHB组[70.47（47.07-92.47）pg/ml]和AHB组[143.69（117.75-208.54）pg/ml],差异均有统计学意义（Z=6.300,P〈0.001;Z=2.505,P=0.012）;而HBV-ACLF患者IL-1Ra与IL-1β比值[2.92（2.20-4.74）]较AHB组[4.54（2.75-6.05）]低,但较CHB患者[2.49（1.50-2.50）]高,差异均有统计学意义（Z=1.966,P=0.048;Z=2.682,P〈0.001）。HBV-ACLF组IL-1β、IL-6、TNFα水平显著高于其他2组（P值均〈0.01）。血清IL-1Ra与TBil、MELD评分均呈负相关（r值分别为-0.506、-0.818,P值均〈0.01）,与凝血酶原活动度（PTA）呈正相关（r=0.475,P=0.007）。结论 IL-1Ra与反映HBV-ACLF严重程度的指标TBil、MELD评分呈负相关,与PTA呈正相关,IL-1ra在HBV-ACLF发病过程中可能起重要作用。Objective To investigate the correlation between serum interleukin- 1 receptor antagonist（ IL- 1Ra） level and disease severity in patients with acute- on- chronic hepatitis B liver failure（ HBV- ACLF）. Methods A total of 31 patients with HBV- ACLF who visited Fuzhou Infectious Disease Hospital from October 2013 to January 2015 were enrolled as study subjects. Another 28 patients with acute hepatitis B（ AHB） and 30 patients with chronic hepatitis B（ CHB） were enrolled as controls. The Q- Plex was used to measure the peripheral blood concentrations of cytokines including IL- 1Ra,interleukin- 1β（ IL- 1β）,interleukin- 6（ IL- 6）,interleukin- 4,interleukin- 10,tumor necrosis factorα（ TNFα）,and interferonγ. Liver function and coagulation function were examined for each group,and the correlations of concentrations of serum cytokines including IL- 1Ra with Model for End- Stage Liver Disease（ MELD） score and HBV DNA were analyzed. The Kruskal- Wallis H test was used for comparison of continuous data between multiple groups,and the Mann- Whitney U test was used for comparison between any two groups; the chi- square test was used for comparison of categorical data between groups. The Spearman rank correlation was used for correlation analysis. Results The IL- 1Ra level and IL- 1Ra / IL- 1β ratio showed significant differences between the three groups（ all P〈0. 05）,and the HBV- ACLF group had a significantly higher IL- 1Ra level than the CHB group and the AHB group [186. 46（ 162. 68-512. 90） pg/ml vs 70. 47（ 47. 07-92. 47） pg/ml,Z =6. 300,P〈0. 001; 186. 46（ 162. 68-512. 90） pg/ml vs 143. 69（ 117. 75-208. 54） pg / ml,Z = 2. 505,P = 0. 012]. The HBV- ACLF group had a significantly lower IL- 1Ra / IL- 1β ratio than the AHB group[2. 92（ 2. 20- 4. 74） vs 4. 54（ 2. 75- 6. 05）,Z = 1. 966,P = 0. 048],but a significantly higher IL- 1Ra/IL- 1β ratio than the CHB group [2. 92（ 2. 20- 4. 74） vs 2. 49（ 1. 50- 2. 50）,Z = 2. 682,P〈0. 001]. The HBV- ACLF group

关 键 词：肝功能衰竭 肝炎 乙型 慢性 白细胞介素1 

分 类 号：R512.62[医药卫生—内科学]