外周血TNFSF15、NLRP3对乙型肝炎肝硬化分级的辅助诊断价值  

Value of peripheral blood TNFSF15 and NLRP3 in the auxiliary diagnosis of hepatitis B cirrhosis

作　　者：黄冠[1] 梁科 洪可 罗霄霄 HUANG Guan;LIANG Ke;HONG Ke;LUO Xiaoxiao(Department of Infectious Diseases,the First People's Hospital of Wuhan Jiangxia District,Wuhan City(Union Jiangnan Hospital Huazhong University of Science and Technology),Wuhan 430200;Department of Infectious Diseases,Central South Hospital Affiliated to Wuhan University;Department of AIDs,Wuhan Jinyintan Hospital,China)

机构地区：[1]武汉市江夏区第一人民医院(华中科技大学协和江南医院)感染性疾病科,湖北武汉430200 [2]武汉大学附属中南医院感染科 [3]武汉市金银潭医院艾滋病科

出　　处：《胃肠病学和肝病学杂志》2022年第7期770-775,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：湖北省卫生健康委员会科研项目(WJ2019F037)。

摘　　要：目的探讨外周血肿瘤坏死因子超家族成员15(tumor necrosis factor superfamily member 15,TNFSF15)、NLRP3对乙型肝炎肝硬化分级的辅助诊断价值。方法选取2017年1月至2020年10月在武汉市江夏区第一人民医院(华中科技大学协和江南医院)治疗的178例乙型肝炎肝硬化患者为研究对象,并以同期96例慢性乙型肝炎患者作为对照。观察乙型肝炎肝硬化患者血清甲胎蛋白(alpha-fetoprotein,AFP)、总胆红素(total bilirubin,TBIL)、白蛋白(albumin,ALB)、TNFSF15、NLRP3 mRNA的表达水平和凝血酶原时间(prothrombin time,PT)的变化情况,分析TNFSF15、NLRP3水平与AFP、TBIL、ALB及PT的相关性;并分析导致患者发生肝硬化的危险因素及外周血TNFSF15、NLRP3水平对肝硬化的辅助诊断价值。结果肝硬化组患者ALB、TNFSF15水平低于慢性乙型肝炎组患者,ALT、AST、AFP、TBIL、NLRP3 mRNA水平高于慢性乙型肝炎组患者(P<0.001),PT明显长于慢性乙型肝炎组。随着肝硬化患者Child-Pugh分级逐渐升高,外周血TNFSF15水平呈逐渐下降趋势,NLRP3 mRNA水平呈逐渐上升趋势,不同分级患者间TNFSF15、NLRP3 mRNA水平比较,差异有统计学意义(P<0.05);Logistic回归分析显示,ALB、ALT、AST、AFP、TBIL、PT、TNFSF15、NLRP3均是影响患者肝硬化发生的独立危险因素;Pearson相关性分析结果显示,TNFSF15表达水平与ALB呈正相关,与ALT、AST、AFP、TBIL、PT呈负相关(P<0.05);NLRP3表达水平与ALB呈负相关,与ALT、AST、AFP、TBIL、PT呈正相关(P<0.05)。ROC分析结果显示,TNFSF15、NLRP3 mRNA两者联合诊断肝硬化曲线下面积为0.867,诊断效能明显高于各单项检测(P<0.05)。结论外周血TNFSF15、NLRP3水平在不同分级的乙型肝炎肝硬化患者中差异显著,并与ALB、PT、TBIL等常用肝功能分级评价指标具有显著相关性,且二者联合检测对肝硬化有较高的辅助诊断价值。Objective To investigate the value of peripheral blood tumor necrosis factor superfamily member 15(TNFSF15)and NLRP3 in the diagnosis of hepatitis B cirrhosis classification.Methods 178 patients with hepatitis B cirrhosis treated in the First People's Hospital of Wuhan Jiangxia District,Wuhan City(Union Jiangnan Hospital Huazhong University of Science and Technology)from Jan.2017 to Oct.2020 were selected as the research objects,and 96 patients with chronic hepatitis B during the same period were used as controls.The expression levels of serum alpha-fetoprotein(AFP),total bilirubin(TBIL),albumin(ALB),TNFSF15 and NLRP3 mRNA and the changes of prothrombin time(PT)in patients with hepatitis B cirrhosis were observed,the correlation between the levels of TNFSF15 and NLRP3 and AFP,TBIL,ALB and PT were analyzed;the risk factors of liver cirrhosis and the auxiliary diagnostic value of peripheral blood TNFSF15 and NLRP3 levels in liver cirrhosis were analyzed.Results The levels of ALB and TNFSF15 in liver cirrhosis group were lower than those in chronic hepatitis B group,and the levels of ALT,AST,AFP,TBIL and NLRP3 mRNA were higher than those in chronic hepatitis B group(P<0.001).PT was significantly longer than that in chronic hepatitis B group.With the gradual increase of Child-Pugh grade in patients with liver cirrhosis,the level of TNFSF15 in peripheral blood gradually decreased and the level of NLRP3 mRNA gradually increased.There was significant difference in the levels of TNFSF15 and NLRP3 mRNA among patients with different grades(P<0.05).Logistic regression analysis showed that ALB,ALT,AST,AFP,TBIL,PT,TNFSF15 and NLRP3 were independent risk factors for liver cirrhosis;Pearson correlation analysis showed that the expression level of TNFSF15 was positively correlated with ALB and negatively correlated with ALT,AST,AFP,TBIL and PT(P<0.05);the expression level of NLRP3 was negatively correlated with ALB and positively correlated with ALT,AST,AFP,TBIL and PT(P<0.05).ROC analysis showed that the area under the curve of

关 键 词：乙型肝炎肝硬化 肿瘤坏死因子超家族成员15 NLRP3 肝硬化分级 诊断价值 

分 类 号：R575.2[医药卫生—消化系统]