病毒性肝炎患者血清肿瘤坏死因子α检测的临床意义

THE DETECTION OF SERUM TUMOR NECROSIS FACTOR ALPHA IN PATIENTS WITH VIRAL HEPATITIS AND ITS CLINICAL SIGNIFICANCE

用放射免疫分析法（ＲＩＡ）测定４５例正常人及２０６例病毒性肝炎病人血清肿瘤坏死因子α（ＴＮＦα）的含量，其中急性黄疸型肝炎（ＡＩＨ）６７例，慢性活动型肝炎（ＣＡＨ）３８例，慢性迁延型肝炎（ＣＰＨ）３６例，肝硬化（ＬＣ）４０例，重症肝炎（ＳＨ）２５例。结果显示，病毒性肝炎病人ＴＮＦα水平较正常人明显增高（２２．４２±１８．３７ｆｍｏｌ／ｍｌ）（Ｐ＜０．００１），且与患者病情轻重密切相关。ＳＨ组ＴＮＦα较ＡＩＨ组明显升高（Ｐ＜０．０１）；ＣＡＨ组ＴＮＦα较ＣＰＨ组明显升高（Ｐ＜０．０１）。二种或二种以上肝炎病毒感染时较单一病毒感染时ＴＮＦα增高（Ｐ＜０．０５）。本文还观察了１０８例病情好转的病人，ＴＮＦα含量也下降（Ｐ＜０．０１），而５例病情恶化的病人ＴＮＦα含量明显增高，最高１例达７８．８０ｆｍｏｌ／Ｌ在病情中ＴＮＦα持续不下降或逐渐上升时，提示病情可能向重型转变，这一结果说明ＴＮＦα水平的变化，可以反映肝细胞病变程度，与病毒性肝炎的活动性相关。

Serum tumor necrosis factor alpha(s TNF α)was measured by radioimmunoassay in 206 patients with different types viral hepatitis and 45 normal persons as controls,The results showed that the s TNFα levels were significantly increased in patients with viral hepatitis as compared with controls(22.42±18.37fmol/ml vs9.45±5.00fmol/ml ,mean±sd P<0.001),and closely related to the severity of disease. The levels of sTNFα were higher in two or more than two hepatitis virus coinfection or superinfection than thosein sigle virus infection inpatients(P<0.05).The sTNFαlevels in 108 patients decreased gradually as their symptoms and signs were improved, while the value of sTNFα in 5 severe cases quikly increased as the conditions were worse(highest to 78.80fmol/ml in one case).The results suggest that the increased level of sTNFα in viral hepatitis may be associated with the degree of injury of hepatocytes and hepatitis activity.