人工肝血浆置换联合DPMAS对HBV相关慢加亚急性肝衰竭miRNA-155水平影响及其作用机制  

Effect of artificial liver plasmapheresis combined with DPMAS on the level of miRNA-155 in patients with HBV-related chronic subacute liver failure and its mechanism

作　　者：黄威 章子旭 HUANG Wei;ZHANG Zi-xu(Huanggang Central Hospital of Yangtze University,Huanggang,Hubei 438000,China)

机构地区：[1]长江大学附属黄冈市中心医院感染性疾病科,湖北黄冈438000 [2]十堰市人民医院感染科,湖北十堰442000

出　　处：《中华医院感染学杂志》2023年第4期547-551,共5页Chinese Journal of Nosocomiology

基　　金：湖北省自然科学基金资助项目(2019CFB415)。

摘　　要：目的分析人工肝血浆置换(PE)联合双重血浆分子吸附(DPMAS)对乙型肝炎病毒相关慢加亚急性肝衰竭(HBV-ACLF)患者微小RNA(miRNA)-155水平影响及其作用机制。方法选取2020年10月-2021年10月黄冈市中心医院收治的HBV-ACLF患者120例为研究对象,随机分为对照组(n=60)和研究组(n=60),对照组给予人工肝PE治疗,研究组在对照组基础上给予DPMAS治疗。比较两组炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]和mi-RNA155水平、肝功能生化指标水平[白蛋白(Alb)、总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)]、HBV DNA转阴率、T淋巴细胞[CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)]、不良反应。结果治疗后,研究组TNF-α、IL-6、miRNA155低于对照组(P<0.05),而Alb高于对照组(P<0.05),TBIL、DBIL、ALT、AST均低于对照组(P<0.05);研究组治疗后4周和8周HBV DNA转阴率均高于对照组(P<0.05);治疗后,研究组CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高于对照组(P<0.05),CD_(8)^(+)低于对照组(P<0.05);两组不良反应差异无统计学意义(P=0.224)。结论人工肝PE联合DPMAS可提升HBV相关慢加亚急性肝衰竭患者HBV DNA转阴率,同时还可提高患者生存率,其作用机制可能与通过降低miRNA-155水平,改善免疫炎症反应有关。OBJECTIVE To analyze the effects of artificial liver plasmapheresis(PE)combined with dual plasma molecular adsorption(DPMAS)on the level of miRNA-155 in patients with hepatitis B virus-associated chronic subacute liver failure(HBV-ACLF)and its mechanism.METHODS A total of 120 patients with HBV-ACLF admitted to Huanggang City Central Hospital from Oct.2020 to Oct.2021 were selected as the study subjects and randomly divided into a control group(n=60)and a study group(n=60).The control group was treated with ARTIFICIAL liver PE,and the study group was treated with DPMAS on the basis of the control group.The levels of inflammatory factors[tumor necrosis factor-a(TNF-a),interleukin-6(IL-6)] and MI-RNA155,liver function biochemical indexes[albumin(Alb),total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)],HBV DNA negative rate,T lymphocytes[CD_(4)^(+)、CD_(8)^(+)andCD_(4)^(+)/CD_(8)^(+)],and adverse reactions were compared between the two groups.RESULTS After treatment,the levels of TNF-a,IL-6 and MI-RNA155 in the study group were significantly lower than those in the control group(P<0.05),while the level of Alb was significantly higher than that in control group(P<0.05),and the levels of TBIL,DBIL,ALT and AST were significantly lower than those in control group(P<0.05).The negative rate of HBV DNA in the study group was significantly higher than that in the control group at 4 and 8 weeks after treatment(P<0.05).After treatment,CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)levels in study group were significantly higher than those in control group(P<0.05),while CD_(8)^(+)levels were significantly lower than those in control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P=0.024).CONCLUSION Compared with artificial liver PE,Artificial liver PE in combination with DPMAS enhanced HBV DNA negative conversion rate and survival rate of patients with HBV-related chronic subacute liver failure.The mechanism of act

关 键 词：人工肝血浆置换 双重血浆分子吸附 乙型肝炎病毒相关慢加亚急性肝衰竭 微小RNA-155 作用机制 

分 类 号：R575.3[医药卫生—消化系统]