乙型肝炎患者肠源性内毒素血症、高组胺血症与细胞免疫功能之间的关系

Correlation of intestinal endotoxemia, histaminemia and cellular immune function in patients with hepatitis B

目的:探讨慢性乙型肝炎患者肠源性内毒素血症(IETM)、组胺与细胞免疫功能之间的关系。方法:慢性乙肝患者80例,根据测定的血浆内毒素水平,将其分为内毒素(ET)阳性组和阴性组,分别检测血清白细胞介素10、12(IL-10、IL-12)、干扰素γ(IFN-γ)、白细胞介素2、4(IL-2、IL-4)浓度,组胺(HA)水平、类胰蛋白酶(TS)释放和AP50单位。结果:各肝炎患者IL-4与IL-10水平明显高于健康人,而IL-12和IFN-γ水平明显低于健康人(P<0.05);按照内毒素分组,阳性组患者IL-4与IL-10水平明显高于阴性组(P<0.05),而IL-12和IFN-γ水平在两组之间无明显差别。AP50、HA、TS水平在肝炎患者均明显高于正常对照组(P<0.05),且在内毒素阳性组均明显高于阴性组。乙肝患者内毒素分别与IL-4、IL-10、AP50及HA呈显著正相关,而HA分别与IL-12、IFN-γ呈明显负相关,与AP50、TS呈明显正相关。内毒素阳性组患者,内毒素水平分别与IL-4、IL-10、AP50及HA水平呈显著正相关,而在阴性组则无此相关性。结论:AP50可以作为IETM存在的标志物,IETM通过激活补体而导致高组胺血症并且长期持续存在,引起细胞免疫功能低下,对肝病非常不利。

AIM： To investigate the correlation of intestinal endotoxemia （IETM）, histaminemia and cellular immune function in the patients with hepatitis B. METHODS： Peripheral blood was collected from patients with chronic hepatitis B （ n = 80） and healthy individuals （ n = 18）. According to plasma endotoxin concentration, total patients were divided into two groups： ET positive and ET negative. Serum IL- 10, IL- 12, IFN-γ, IL- 2, IL- 4 concentrafions were detected. In addition, the serum histamine （HA）, tryptase （TS） and AP50 levels were studied. RESULTS： Compared to control group, the concentrations of IL- 4 and IL- 10 were increased, but IL- 12 and IFN -γ were decreased obviously in total patients （ P 〈 0.05）. The levels of IL- 4 and IL- 10 in ET positive group were higher than that in ET negative group （ P 〈0.05）. The level of IL- 12 and IFN-γ had no statistical difference between two groups. AP50, HA and TS levels were increased significantly in total patients compared with control group, and the levels of ET positive were higher than that in ET negative group （ P 〈 0.05）. Furthermore, in total patients, ET was correlated with IL- 4, IL- 10, AP50 and HA, respectively. HA was negatively correlated with IL - 12 and IFN - T, and correlated with AP50 and TS. In ET positive group, ET was correlated with IL- 4, IL-10, AP50 and HA, respectively, which did not exist in ET negative group. CONCLUSION： AP50 may be a sign of IETM. IETM may be disbenefit to hepatitis B through activating complement, which leads to histaminemia and poor cellular immune function.