聚乙二醇干扰素α治疗对慢性乙型肝炎患者血清炎症因子水平的影响

Changes and clinical significance of Th17-related inflammatory factors in peripheral blood before and after Peg-IFNα treatment in patients with chronic hepatitis B

目的分析慢性乙型肝炎患者聚乙二醇干扰素α(Peg-IFNα)治疗前后外周血辅助性T细胞17(Th17)相关炎症因子[白细胞介素(IL)-17A、IL-22)]表达水平变化及临床意义。方法回顾性选取2019年1月至2020年6月山西运城市中心医院收治的137例初诊慢性乙型肝炎患者作为研究对象,予以Peg-IFNα-2a皮下注射治疗,依据病毒学应答与否分为应答组(n=63)和无应答组(n=74)。检测两组患者血常规、肝功能、HBV指标(HBsAg和HBeAg)、HBV DNA水平,以及治疗前、治疗后1、3、6、12个月的IL-17A及IL-22水平并进行统计学分析;以IL-17A中位水平基点,分析外周血IL-17A水平与病毒学应答率的关系。结果应答组ALT水平高于无应答组,HBsAg、HBeAg和HBV DNA水平均低于无应答组,差异均有统计学意义(P<0.05)。应答组治疗后IL-17A水平较治疗前显著下降,差异有统计学意义(P<0.05),而无应答组治疗前后IL-17A水平差异无统计学意义(P>0.05);应答组治疗后1、3、6、12个月的IL-17A水平均低于无应答组,差异均有统计意义(P<0.05)。两组治疗后IL-22水平相比差异无统计学意义(P>0.05)。IL-17A高表达患者治疗后3、6、12个月的病毒学应答率显著低于IL-17A低表达患者,差异有统计学意义(P<0.05)。结论Th17相关细胞因子IL-17A的低表达,可能是导致慢性乙型肝炎患者Peg-IFNα治疗失败的原因,会提高患者的病毒学应答率,在治疗过程中应根据指标变化动态调整用药方案。

Objective To analyze the changes in peripheral blood T helper 17 cell(Th17)-related cytokine[interleukin(IL)-17A,IL-22]expression and its clinical significance before and after treatment with pegylated interferon alpha(Peg-IFNα)in patients with chronic hepatitis B.Methods A total of 137 newly diagnosed patients with chronic hepatitis B admitted to Yuncheng Central Hospital from January 2019 to June 2020 were selected as the research subjects and received subcutaneous injection of Peg-IFNα-2a.According to the virological response or not,they were divided into response group and non-response group.The blood routine,liver function,HBV index(HBsAg and HBeAg),HBV DNA,IL-17A and IL-22 levels of the two groups before treatment,1,3,6,12 months after treatment were dynamically tested were analyzed.Based on the median level of IL-17A,the relationship between the level of IL-17A in peripheral blood and the virological response rate was analyzed.Results The level of ALT in the response group was higher than that in the non response group,and the levels of HBsAg,HBeAg and HBV DNA were lower than those in the non response group,and the differences were statistically significant(P<0.05).The level of IL-17A in the response group decreased significantly after treatment,and the difference was statistically significant(P<0.05),and the level of IL-17A in the non-response group did not change significantly after treatment(P>0.05).The levels of IL-17A in the response group were lower than those in the non response group at 1,3,6,12 months after treatment,and the differences were statistically significant(P<0.05).There was no statistically significant difference in IL-22 levels between the two groups after treatment(P>0.05).The virological response rate of patients with high IL-17A expression at 3,6 and 12 months after treatment was significantly lower than that of patients with low IL-17A expression,and the difference was statistically significant(P<0.05).Conclusion The low expression of TH17-related cytokine IL-17A may be the cause of peG-IFNαtreatment failure in patients with chronic hepatitis B,which can improve the virological response rate of patients,and the medication regimen should be dynamically adjusted according to the changes of indicators during treatment.