慢性重型肝炎患者血中LPS、LBP和sCD14的水平及其临床意义

CHANGES IN BLOOD LIPOPOLYSACCHARIDE, LIPOPOLYSACCHARIDE-BINDING PROTEIN、SOLUBLE CD14 LEVEL AND ITS CLINICAL SIGNIFICANCE IN PATIENTS WITH CHRONIC SEVERE VIRAL HEPATITIS B

探讨LBP、sCD14水平在慢性重型肝炎 (慢重肝 )患者伴肠源性内毒素血症中的作用。应用基质显色法和ELISA双抗体夹心法 ,检测 2 4例慢重肝患者血中LPS、LBP和sCD14的水平 ,并以 10名献血员和 16例慢性乙型肝炎患者作为对照。结果慢重肝患者在早期、中期、晚期 ,其血中LPS、LBP和sCD14的水平均明显高于慢乙肝患者及献血员 ;慢重肝死亡者其LPS、LBP和sCD14的水平也显著高于存活者。提示慢重肝患者伴肠源性内毒素血症时 ,血清中LBP和sCD14的水平 ,可显著提高机体对内毒素的敏感性。在内毒素浓度较低时 ,仍可诱导Kupffer细胞释放TNF α,从而加剧肝细胞损伤。

To explore the changes in blood levels of lipopolysaccharide(LPS), lipopolysaccharide-binding protein(LBP),and soluble CD14 (sCD14), and their clinical significance in patients with severe chronic viral hepatitis B. blood levels of LPS were determined with chromogenic limulus amebocyte lysate assay, and LBP and sCD14 were assayed with ELISA in 24 patients of severe chronic viral hepatitis B. 10 normal subjects and 16 patients with chronic hepatitis B were also enrolled as controls. The results showed that the blood levels of LPS, LBP and sCD14 were significantly higher in patients with the early stage, midterm, late periods of severe chronic viral hepatitis B than in normal subjects and in those with chronic hepatitis B. The blood levels of LPS, LBP and sCD14 were also significantly higher in patients who died of severe chronic viral hepatitis B than in survivors of the same disease. It suggested that when patients with severe chronic viral hepatitis B were complicated by intestinal endotoxemia (IETM), the sensitivity of Kupffer cells to endotoxin was significantly increased, resulting in hepatocyte injury by TNF α,even in the presence of very low endotoxin concentration .