慢性丙型病毒性肝炎抗病毒治疗患者炎症因子动态变化及临床意义

Dynamic changes and clinical significance of inflammatory factors in patients with chronic hepatitis C after antiviral therapy

目的分析慢性丙型病毒性肝炎(简称丙肝)抗病毒治疗患者炎症因子动态变化及临床意义,为抗病毒治疗提供经验指导。方法前瞻性纳入医院2019年1月-2021年1月治疗的慢性丙肝患者作为研究对象,给予患者抗病毒药物治疗24周,分别于治疗前、治疗8、12、24周测定血清白细胞介素-10(IL-10)、白细胞介素-18(IL-18)水平;治疗结束后随访1年,统计患者随访期间肝硬化发生情况,分析血清IL-10、IL-18动态变化与慢性丙肝抗病毒治疗患者肝硬化的关系。结果本研究共纳入98例慢性丙肝患者进行研究,95例患者按规定完成24周的规范治疗。随访结果显示,95例患者发生肝硬化15例(15.79%)。肝硬化组丙型肝炎病毒RNA(HCV-RNA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素水平高于非肝硬化组,差异有统计学意义(P<0.05);肝硬化组和非肝硬化组治疗8、12、24周血清IL-10、IL-18水平均较治疗前降低,且非肝硬化组较肝硬化组低,差异有统计学意义(P<0.05);两组治疗前血清IL-10、IL-18水平比较,差异无统计学意义(P>0.05);经点二列相关性分析显示,治疗8、12、24周血清IL-10、IL-18水平与慢性丙肝抗病毒治疗患者肝硬化发生情况均呈正相关(r>0,P<0.05);绘制受试者工作特征(ROC)曲线,结果显示,治疗8周、12周、24周血清IL-10及IL-18预测慢性丙肝抗病毒治疗患者肝硬化的曲线下面积(AUC)均>0.7,均具有一定的预测价值,且在治疗24周时血清IL-10、IL-18预测价值最佳。结论血清IL-10及IL-18动态变化与慢性丙肝抗病毒治疗患者肝硬化密切相关,且对患者抗病毒治疗效果具有较高的预测价值。

Objective To analyze the dynamic changes and clinical significance of inflammatory factors in patients with chronic hepatitis C(hereinafter referred to as hepatitis C)undergoing antiviral therapy,and provide experience guidance for antiviral therapy.Methods The patients with chronic hepatitis C who were prospectively included in the hospital from January 2019 to January 2021 were treated with antiviral drugs for 24 weeks.The serum levels of interleukin-10(IL-10)and interleukin-18(IL-18)were measured before treatment and at the 8th,12th and 24th weeks after treatment.The patients were followed up for 1 year after treatment.The incidence of liver cirrhosis during the follow-up period was counted,and the relationship between the dynamic changes of serum IL-10,IL-18 and liver cirrhosis in patients with chronic hepatitis C antiviral therapy was analyzed.Results A total of 98 patients with chronic hepatitis C were enrolled in this study,and 95 patients completed standard treatment for 24 weeks as required.The follow-up results showed that 15 of 95 patients(15.79%)developed cirrhosis.Hepatitis C virus RNA(HCV-RNA),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin levels in cirrhosis group were higher than those in non-cirrhosis group,with a statistically significant difference(P<0.05).The levels of IL-10 and IL-18 in serum of cirrhosis group and non-cirrhosis group at 8,12 and 24 weeks after treatment were lower than those before treatment,and the levels of IL-10 and IL-18 in non-cirrhosis group were lower than those in cirrhosis group,with a statistically significant difference(P<0.05).There was no statistically significant difference in serum IL-10 and IL-18 levels between the two groups before treatment(P>0.05).The point binary correlation analysis showed that the serum IL-10 and IL-18 levels at the 8th,12th and 24th weeks of treatment were positively correlated with the occurrence of liver cirrhosis in patients with chronic hepatitis C antiviral treatment(r>0,P<0.05).The ROC curve of the subjects was drawn.The results showed that the area under the curve(AUC)predicted by serum IL-10 and IL-18 at 8,12 and 24 weeks of treatment in patients with chronic hepatitis C treated with antiviral therapy was greater than 0.7,which had certain predictive value,and the serum IL-10 and IL-18 at 24 weeks of treatment had the best predictive value.Conclusion The dynamic changes of serum IL-10 and IL-18 are closely related to liver cirrhosis in patients with chronic hepatitis C treated with antiviral therapy,and have a high predictive value for the effect of antiviral therapy.