可溶性细胞间粘附分子-1在慢性乙型肝炎的临床意义

The Clinical Significance of Soluble Intercellular Adhesion Molecule-1 in Patients with Chronic Hepatitis B

目的观察慢性乙型肝炎患者血清可溶性细胞间粘附分子-1(sICAM-1)的变化,探讨其临床意义及在发病机制中的作用。方法采用酶联免疫吸附试验(ELISA)法测定56例慢性乙肝患者(其中慢性轻度20例、中度24例、重度6例、慢性重型6例)血清sICAM-1水平,同时检测血清肿瘤坏死因子-α(TNF-α)、肝功能,并以20例健康人员作对照。结果 (1)慢性乙肝患者血清sICAM-1水平(轻度682.56±267.39ng/ml,中度934.34±512.84ng/ml,重度1739.63±492.53ng/ml,慢性重型1753.40±197.79ng/ml)明显高于对照组(439.47±93.54ng/ml),按轻度、中度、重度、慢性重型的顺序依次升高。(2)随着慢性乙肝肝细胞受损程度的加重,血清sICAM-1水平逐渐升高,AST>110U/L组、ALT>280U/L组、SB>85.5μmol/L组血清sICAM-1水平明显高于肝功能轻度异常和正常组(P<0.01和P<0.05),且与AST呈显著正相关(γ=0.6673,P<0.01)。随着病情的好转,血清sICAM-1水平明显下降。(3)慢性乙肝患者血清TNF-α水平均高于对照组,且按轻度、中度、重度、慢性重型依次升高,血清sICAM-1水平与血清TNF-α呈正相关(慢性轻度γ=0.805,P<0.05;慢性中度γ=0.871,P<0.01;慢性重度γ=0.56,P<0.05;慢性重型γ=0.582,P<0.05)。结论 (1)慢性乙型肝炎患者血清sICAM-1水平明显高于对照组,并随着病情的发展逐渐升高,表明慢性乙肝患者血清sICAM-1水平升高,且与病情的严重程度相一致。(2)血清sICAM-1水平随着AST、ALT、SB水平的升高而逐渐增长,并与AST呈显著正相关,因此临床检测血清sICAM-1可以反映肝细胞受损程度,并对观察疗效、判断预后有一定价值。(3)慢性肝炎患者血清TNF-α水平高于正常对照,且随着其水平的升高,血清sICAM-1水平逐渐升高,二者具有相关性。提示TNF-α的升高与血清sICAM-1的产生和分泌有着密切关系。总之,慢性乙肝患者血清sICAM-1水平明显升高,其原因与炎症细胞因子关系密切,TNF-α等可直接或间接地提高sICAM-1分泌;血清sICAM-1水平与AST、ALT、SB关系密切,可反映肝细胞损伤程度和肝组织炎症活动程度;另外,血清sICAM-1水平可用于观察疗效、判定预后。

Objective To observe the prevalence of serum soluble intercellular adhesion molecule-1 (sICAM-1) in chronic hepatitis B (CHB) and evaluate its role in the pathogenesis and its clinical value. Methods sICAM-1 was detected by ELISA and serum tumor necrosis factor-α (sTNF-α) and liver function were assayed in 56 patients with CHB. 20 healthy persons were served as normal controls (NC). Results (1) sICAM-1 in patients with different degrees of CHB (mild, moderate, heavy and severe hepatitis) was 682.56±267.39ng/ml, 934.34±512.84ng/hal, 1739.63±492.53ng/ml and 1753. 40±197.79ng/ml, respectively. The levels of sICAM-1 and sTNF-α in each group of the patients were significantly higher than those in NC, and it also was found that the levels of sICAM-1 and sTNF-α were increased as CHB became severe. (2) The patients were classified as group 1 (AST>110U/L, ALT>300U/L, and SB>85.5μmol/L) and group 2 (AST<110U/L, ALT<300U/L, and SB<85.5/μmol/L) according to their liver function. The results showed that sICAM-1 in group 1 was higher than in group 2 and the levels of sICAM-1 was positively correlated with the levels of AST (γ=0.6673, P<0.01) and sTNF-α(γ=0.805 in mild group, P<0.05; γ=0.871 in moderate group, P<0.01; γ=0.56 in heavy group, P<0.05; γ=0.582 in severe group, P<0.05). Conclusions The results showed that sICAM-1 in patients with CHB is consistent with liver damage and its detection is valuable to observe the curative effects and estimate prognosis of the diseases. In addition, it was found that sTNF-α might enhance the production of sICAM-1.