急性肝炎血清免疫抑制酸性蛋白变化的因素和作用

The factors and effects of the changes of serum immunosuppressive acidic protein in patients with acute hepatitis

目的 探讨急性肝炎血清IAP水平变化的影响因素及其对免疫功能的影响。方法血清IAP采用单向免疫扩散法检测。统计分析采用SPSS11．5软件。对血清IAP水平与血清白蛋白、前白蛋白水平和外周血中性粒细胞、中间值细胞绝对计数进行Spearman双变量相关和直线回93分析。对血清IAP水平与外周血CD^＋淋巴细胞、CD8^＋淋巴细胞、CD19^＋淋巴细胞、CD56^＋淋巴细胞绝对计数和血清免疫球蛋白G，免疫球蛋白A、免疫球蛋白M，免疫球蛋白E水平进行Spearman双变量相关和偏相关分析。结果 74例急性肝炎病人血清IAP异常降低率和异常升高率分别为22．97％（17／74）和13．5l％（10／74），两者相比无显著性差异（P〉0．05）。血清IAP水平与血清白蛋白水平之间无显著相关性（r=-0．209，P=0．075），与血清前白蛋白之间呈显著正相关（r=0．334，P=0．004）；血清IAP水平与外周血中性粒细胞和中间值细胞绝对计数之间无显著相关性（r=0．076，P=0．076和r=0．065，P=0．585）。血清前白蛋白水平为影响血清IAP水平的主要因素（偏回归系数=1．061，P=0．015）。血清IAP水平与外周血各淋巴细胞亚群绝对计数之间均无显著相关性（P〉0．05），与血清各类免疫球蛋白水平之间均无显著相关性（P〉0．05）。结论 代表肝脏贮备功能急性下降的血清前白蛋白为影响急性肝炎血清IAP水平的主要因素。正常参考值范围和正常参考值以下的血清IAP水平对机体免疫功能没有显著抑制作用。

Objective To explore the influence factors of the changes of serum immunosuppressive acidic protein （IAP） and the effects of serum IAP on immune function in patients with acute hepatitis. Methods Serum IAP was tested by one-way immunodiffusion assay. SPSS 11.5 software was applied for statistical analyses. Spearman bivariate correlation and linear regression analyses of serum IAP level with serum albumin, prealbumin and peripheral blood neutrophilic granulocyte count, mid cell count were performed. Spearman bivariate correlation and partial correlation analyses of serum IAP level with peripheral blood CD4^＋, CD8^＋, CD19^＋, CD56^＋ lymphocyte count and serum immunoglobulin G A, M, E level were performed. Results The rates of abnormal decrease （less than the lower limit of normal reference） and abnormal increase （more than the upper limit of normal reference） of serum IAP were 22.97% （17/74） and 13.51% （10/74）, respectively, and there was no significant difference between them （P〉0.05）. Serum IAP level was not related evidently with serum albumin （r=-0.209, P=0.075）, and was related evidently positively with prealbumin level （r=0.334, P=0.004）; Serum IAP level was not related with both peripheral blood neutrophilic granulocyte and mid cell count （r=0.076, P=0.076 and r=0.065, P=0.585）. Serum prealbumin level was the leading factor of influencing serum lAP level （unstandardized regression coefficient =1.061, P=0.015）. Serum IAP level was not correlated with peripheral blood CD4^＋, CD8^＋, CD19^＋ and CD56^＋ lymphocyte count （P〉0.05）, and was not correlated with serum immunoglobulin C A, M, E （P〉0.05）. Conclusions Serum prealbumin level representing the acute decline of liver function is the leading factor of influencing serum IAP level. Serum IAP within the range of normal reference and under the limit of normal reference has no suppressiveeffect on the immune function.