重度慢性乙型肝炎预后危险因素及其外周血单个核细胞凋亡分子水平  

Risk factors for prognosis of patients with severe chronic hepatitis B and value of peripheral blood mononuclear cell apoptosis molecule in prediction of prognosis

作　　者：陈惠珍[1] 杨筱敏[1] 卢靖 郑琼蕾 陈晓洁[1] 齐艳红 CHEN Hui-zhen;YANG Xiao-min;LU Jing;ZHENG Qiong-lei;CHEN Xiao-jie;QI Yan-hong(Yuying Children′s Hospital,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang325000,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院全科医学科,浙江温州325000

出　　处：《中华医院感染学杂志》2021年第18期2734-2737,共4页Chinese Journal of Nosocomiology

基　　金：浙江省教育厅基金资助项目(Y202044447)。

摘　　要：目的探讨慢性乙型肝炎(CHB)重度患者外周血单个核细胞(PBMC)中凋亡分子水平与病毒载量、肝功能关联性及预后预测效能。方法选取2017年4月-2020年7月温州医科大学附属第二医院237例CHB重度患者为研究对象,根据患者6个月预后分为生存组(n=203)与病死组(n=34)。比较两组临床资料、乙型肝炎病毒(HBV)DNA载量、肝功能指标[谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)]水平、PBMC中凋亡分子[FAS、FAS配体(FASL)、胱天蛋白酶-3(CASP3)、CASP9]水平,分析CHB重度患者预后危险因素,探讨PBMC中凋亡分子水平对CHB重度患者病死的预测价值。结果病死组PBMC中FAS、FASL、CASP3、CASP9 mRNA均高于生存组(P<0.05)。HBV-DNA载量、ALT、AST、TBIL、PBMC中FAS、FASL、CASP3、CASP9含量均为CHB重度患者预后危险因素(P<0.05)。CHB重度患者PBMC中凋亡分子FAS、FASL、CASP3、CASP9 mRNA与HBV-DNA载量、ALT、AST、TBIL水平呈正相关关系(P<0.05)。PBMC中FAS、FASL、CASP3、CASP9联合预测CHB重度患者病死曲线下面积为0.821,敏感度、特异度分别为73.53%、82.76%。结论CHB重度患者PBMC中凋亡分子水平与病毒载量、肝功能均存在正相关性,早期明确PBMC中凋亡分子水平,可为评估CHB重度患者肝功能损伤、预测预后提供一条有效途径。OBJECTIVE To explore the relationship between the apoptosis molecules in peripheral blood mononuclear cells(PBMC)and the viral load,liver function and analyze its efficiency in prediction of prognosis of the patients with chronic hepatitis B(CHB).METHODS A total of 237patients with severe CHB who were treated in the Second Affiliated Hospital of Wenzhou Medical University from Apr 2017to Jul 2020were recruited as the study subjects and divided into the survival group with 203cases and the death group with 34cases according to 6-month prognosis.The clinical data,hepatitis B virus(HBV)DNA load,liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL)]levels,and apoptosis molecules in PBMC[FAS,FAS ligand(FASL),Caspase-3(CASP3),CASP9]levels were compared between the two groups,the risk factors for prognosis of the patients with severe CHB were observed,and the value of PBMC apoptosis molecules in prediction of mortality of the patients was analyzed.RESULTS The levels of FAS,FASL,CASP3and CASP9mRNA in PBMC of the death group were significatly higher than those of the survival group(P<0.05).The HBV-DNA load,ALT,AST,TBIL,and FAS,FASL,CASP3and CASP9in PBMC were the risk factors for prognosis of the patients with severe CHB(P<0.05).The apoptosis molecules FAS,FASL,CASP3and CASP9mRNA in PBMC of the patients with severe CHB were positively correlated with the HBV-DNA load,ALT,AST and TBIL(P<0.05).The area under curve of the joint detection of FAS,FASL,CASP3and CASP9 in PBMC was 0.821in prediction of mortality of the patients with severe CHB,with the sensitivity 73.53%,the specificity 82.76%.CONCLUSIONThe apoptosis molecules in PBMC of the patients with severe CHB are positively correlated with the viral load and liver function.The detection of apoptosis molecules in PBMC in early stage is an effectively way to assess the damage of liver function and prediction of prognosis.

关 键 词：慢性乙型肝炎 重度 外周血单个核细胞 凋亡分子 病毒载量 肝功能 预后 

分 类 号：R512.62[医药卫生—内科学]