可溶性CD40在肝病患者血清中的表达及其临床意义

Serum levels and clinical significance of soluble CD40 in liver disease

目的:研究可溶性CD40(solubleCD40,sCD40)在急性肝炎、重型肝炎和原发性肝癌患者血清中的表达,探讨其与生化指标和疾病预后的关系。方法:使用酶联免疫吸附实验(ELISA)检测急性肝炎(49例)、重型肝炎(22例)和原发性肝癌(13例)患者入院次日清晨空腹血清标本和健康体检者(44例)血清标本中sCD40浓度,分析其与急性肝炎患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)的关系,并初步探讨sCD40水平与重型肝炎患者疾病预后的关系。流式细胞术检测患者血清sCD40与CD40配体(CD40L)的结合活性。结果:三种肝脏疾病患者血清中sCD40水平(149.70±86.82)pg/mL较健康对照组(47.33±27.49)pg/mL显著升高(P<0.001),但各组患者之间无统计学意义(P=0.475)。重型肝炎死亡患者血清sCD40浓度较存活患者显著升高(P<0.05)。急性肝炎患者血清sCD40浓度与ALT、AST水平呈显著正相关(r=0.50,P<0.001;r=0.47,P<0.01)。体外实验显示患者血清sCD40具有与CD40L结合的活性。结论:肝脏疾病患者血清异常高表达sCD40,这是评价急性肝细胞损伤的辅助指标,有助于判断重型肝炎患者的病情和预后。CD40-CD40L作用可能参与了肝细胞损伤和免疫失调的病理过程。

AIM： To measure the level of serum soluble CD40 （sCD40） in patients with acute hepatitis, hepatitis gravis and primary carcinoma of the liver, and to evaluate the relationship of sCD40 with biochemical marks and disease prognosis. METHODS： Patients with acute hepatitis （n = 49） hepatitis gravis （ n = 22） and primary carcinoma of the liver （n = 13） were studied, and serum sCD40 was determined in these patients and compared with that of healthy controls （n = 44） by enzyme linked immunosorbent assay （ELISA）. The binding capacity of serum sCD40 to its ligand CD40L was detected by flow cytometry （FCM） in vitro. RE. SULTS： Concentration of sCD40 was significantly higher in patients with liver disease than that in healthy controls （ P 〈 0.001 ）, but no significant difference was found between the three types of liver disease （P = 0. 475）. In the hepatitis gravis group, sCD40 concentration in dead patients was higher compared with that in the survivals （P 〈0.05）. Level of sCD40 in patients with acute hepatitis was correlated with serum alanine transaminase （ALT） and aspartic transaminase （AST）. The serum sCD40 could bind CD40L in vitro. CONCLUSION： These data suggest that sCD40 is an important serological marker in liver disease to evaluate acute injury of hepatocytes, and it shows a relevance with the prognosis of hepatitis gravis. The highly elevated level of sCD40 suggest the involvement of CD40 and its ligand CD40L in liver disease.