髓样细胞触发受体2在乙型肝炎病毒相关慢加急性肝衰竭预后判断中的意义  

Significance of triggering receptor expressed on myeloid cells-2 prognostic evaluation in hepatitis B virus-related acute-on-chronic liver failure

作　　者：陈思霖 李小鹏[3] 高莉[1] 车媛梅[1] 张伦理[1] 程晓宇[1] Chen Silin;Li Xiaopeng;Gao Li;Che Yuanmei;Zhang Lunli;Cheng Xiaoyu(Center for Diagnosis and Treatment of Infectious Diseases,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Gastroenteroloy,the Seventh Affiliated Hospital of Guangxi Medical University(Wuzhou Gongren Hospital),Wuzhou 543001,China;The First Afliated Hospital Key Laboratory of Liver Regenerative Medicine of Jiangxi Province,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院感染性疾病诊疗中心,南昌330006 [2]广西医科大学第七附属医院(梧州市工人医院)消化内科,梧州543000 [3]南昌大学第一附属医院江西省肝脏再生医学重点实验室,南昌330006

出　　处：《中华肝脏病杂志》2023年第12期1306-1312,共7页Chinese Journal of Hepatology

基　　金：江西省卫生健康委科技计划(SKJP 220229771);江西省科技厅人才资助计划(20161BCD40015)。

摘　　要：目的探讨髓样细胞触发受体2(TREM-2)在HBV相关慢加急性肝衰竭(HBV-ACLF)疾病预后判断中的意义,以期为临床上HBV-ACLF患者的预后判断提供新的生物学标志物。方法将研究对象分为实验组及对照组,实验组:选取2019年1月1日至2019年12月31日于南昌大学第一附属医院感染科收治的HBV-ACLF患者50例,依据患者出院时的实际预后情况将其分为生存组及死亡组(自动出院及死亡患者均视为死亡组,所有入组患者住院时间均超过28d)。对照组:健康人25名。采集实验组及对照组外周静脉血,分离出血浆及外周血单个核细胞(PBMC),检测其血浆中的TREM-2、白细胞介素(IL)-6、IL-8的浓度,检测PBMC中TREM-2的mRNA的表达。对照组只采集1次血液样本,而实验组则动态采取5次血液样本,时间分别为入院当天,开始治疗后7、14、21、28 d。同时监测HBV-ACLF患者入院时的相关临床指标,包括肝功能丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、白蛋白及凝血功能国际标准化比值、凝血酶原时间等指标。计量资料以均数±标准差(x±s)表示。计数资料应用χ^(2)检验进行比较分析;组内均数的比较采用重复测量因素的方差分析;用t检验对两组间的均数进行分析;两个变量间的相关性分析采用双变量相关分析;用受试者操作特征(ROC)曲线对TREM-2作为诊断标志物的价值进行分析。结果HBV-ACLF患者PBMC中TREM-2的mRNA表达在生存组的各个时间点呈现出逐渐增加的趋势,且28 d时显著高于对照组(P<0.01)。而在死亡组的各个时间点呈现出逐渐减弱的趋势,于28 d时显著低于对照组(P<0.01)。(1)HBV-ACLF患者血浆中的TREM-2的含量在生存组的各个时间点总体上呈现出逐渐增加的趋势,入院当天、开始治疗后7、14、21、28 d的水平分别为(1.49±0.85)、(1.62±0.58)、(1.95±0.69)、(2.33±0.71)、(2.00±0.67)ng/ml。而死亡组TREM-2的表达在各个时间点呈现出逐渐减弱Objective To explore the significance of triggering receptor expressed on myeloid cells-2(TREM-2)prognostic evaluation so as to provide novel biological markers in clinical practice for patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods The research subjects of this study were divided into an experimental group and a control group.Fifty HBV-ACLF cases admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Nanchang University from January 1,2019 to December 31,2019 were selected as the experimental group.Patients were divided into survival and death groups according to the actual prognosis at discharge(self-discharge and dead patients were considered death groups,and all enrolled patients were hospitalized for more than 28 days).Twenty-five healthy subjects were chosen as the control group.Peripheral venous blood was collected from the experimental group and the control group.Plasma and peripheral blood mononuclear cells(PBMC)were isolated.The concentrations of TREM-2,interleukin(IL)-6,and IL-8 were detected in the plasma.TREM-2 mRNA expression was detected in PBMC.A single blood sample was collected from the control group,whereas five blood samples were dynamically collected from the experimental group on the day of admittance and at 7,14,21,and 28 days after treatment commenced.Simultaneously,upon admission,the relevant clinical indicators of HBV-ACLF patients were monitored,including the liver function test:alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,coagulation function test:international normalized ratio,prothrombin time,and other indicators.Measurement data were expressed as mean±standard deviation(■±s).Count data were compared and analyzed using the χ^(2) test.The intra-group factor mean was compared using a repeated measures ANOVA.The means were analyzed by t-tests between the two groups.Bivariate correlation analysis was used to analyze the correlation between the two variables.The value of TREM-2 as

关 键 词：髓样细胞触发受体2 HBV相关慢加急性肝衰竭 白细胞介素-6 白细胞介素-8 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]