慢性乙型肝炎患者血清sCD14的水平与肠源性内毒素血症的关系

Relationship between serum sCD14 levels and intestinal endotoxemia in patients with chronic hepatitis B

目的 探讨慢性乙型肝炎（慢乙肝）患者血清中sCD14的水平与继发肠源性内毒素血症的关系。方法 以ELISA法检测60例慢乙肝患者血清sCD14和TNF-(水平，同时，应用基质显色法定量检测了患者血浆内毒素水平并将三者与对照组进行比较。结果 轻度慢乙肝（A组）患者血清sCD14水平与对照组无显著差异（P>0.05），中度慢乙肝（B组）和重度慢乙肝（C组）sCD14水平均显著高于对照组（P<0.01）；慢乙肝继发肠源性内毒素血症者血清中sCD14s为（4.8±2.3）(g/ml，而无继发肠源性内毒素血症者其sCD14为（2.9±1.9）(g/ml，两者之间有显著差异 ( P<0.01)。A组患者血清中sCD14水平为（3.0±1.7）(g/ml，而TNF-(为（4.69±2.75）ng/ml，两者之间无显著相关性（γ= 0.76，P>0.05）；而B组和C组其sCD14水平分别为（5.2±2.1）(g/ml和（6.9±3.4）(g/ml，TNF-(分别为（9.48±6.15）ng/ml和（14.23±8.29）ng/ml，B组、C组的sCD14水平分别与自身组TNF-(有显著相关性（γ=0.87，P<0.01；γ=0.91，P<0.01）。结论 慢乙肝继发肠源性内毒素血症者sCD14水平显著升高，说明sCD14水平可显著提高慢乙肝患者对内毒素的敏感性，LPS与sCD14结合，诱导单核-巨噬细胞产生TNF-(，从而损伤肝细胞。

Objective To explore the relationship between serum soluble CD14 (sCD14) levels and intestinal endotoxemia (IETM) in patients with chronic hepatitis B. Methods Serum sCD14 and tumor necrosis factor-( (TNF-() levels in 60 patients with chronic hepatitis B were measured by enzyme-linked immunosorbent assay (ELISA) method, and lipopolysaccharide (LPS) level with chromogenic limulus amebocyte lysate (LAL) assay. Results The levels of sCD14 in patients with moderate chronic hepatitis B（group B）and in those with severe type (group C) were higher than that in control group (P<0.01), but no difference was found between patients with mild chronic hepatitis B (group A) and control group (P>0.05). sCD14 levels in chronic hepatitis B patients with IETM were (4.8±2.3) (g/ml, but when IETM were not present, the levels were (2.9±1.9) (g/ml, and there was significant difference between these 2 groups (P<0.01). sCD14 levels in group A were (3.0±1.7) (g/ml, but TNF-( levels were (4.69±2.75) ng/ml, and no significant correlation between sCD14 and TNF-( levels was observed in group A (γ= 0.26, P>0.05); sCD14 levels in group B and group C were (5.2±2.1) (g/ml, (6.9±3.4) (g/ml, TNF-( levels were (9.48±6.15) ng/ml, (14.23±8.29) ng/ml, respectively. sCD14 and TNF-( were significantly correlated with each other in group B and group C (γ=0.87, P<0.01;γ=0.91, P<0.01). Conclusion sCD14 levels were significantly higher in patients with chronic hepatitis B succedent to IETM, which can significantly increase the vulnerability of the patients to endotoxin LPS. The binding of LPS with sCD14 may induce the production of TNF-( by mono-macrophages resulting in hepatocyte injury.