华支睾吸虫病患者血清中细胞间黏附分子水平及对肝功能的影响

Serum Level of Intercellular Adhesion Molecule-1 in Patients with Clonorchiasis and its Impact on Liver Function

目的了解华支睾吸虫病患者细胞间黏附分子(ICAM-1)水平的动态变化,探讨其与肝功能的关系。方法分别采集50例未经治疗的华支睾吸虫病患者和20位健康献血者(对照组)静脉血5 ml,检测血浆中总胆红素(TBIL)、白蛋白(ALB)和谷氨酸转氨酶(ALT)含量,参照Child-Pugh肝功能分级法,根据肝功能受损程度,将华支睾吸虫病患者分成Ⅰ、Ⅱ和Ⅲ3组。采用双抗体夹心ELISA法,检测血清可溶性ICAM-1(sICAM-1)水平。采用放射免疫分析法检测血清白细胞介素-4(IL-4)、IL-6和肿瘤坏死因子-α(TNF-α)含量。采用鲎三肽基质染色定量法检测血浆细菌脂多糖(LPS)水平。结果华支睾吸虫病患者血清或血浆中sICAM-1、LPS、IL-4、IL-6、TNF-α、TBIL和ALT的含量[分别为(729.34±75.67)μg/ml、(0.18±0.08)Eu/ml、(3.46±0.38)ng/ml、(223.48±46.90)pg/ml、(1.39±0.62)ng/ml、(15.45±10.81)μmol/L和(39.25±8.82)IU/L]明显高于对照组[(269.15±38.21)μg/ml、(0.07±0.03)Eu/ml、(0.74±0.22)ng/ml、(106.06±32.96)pg/ml、(0.56±0.14)ng/ml、(6.31±4.70)μmol/L和(18.43±9.81)IU/L](P<0.05或P<0.01),ALB含量[(28.35±5.38)g/L]明显低于对照组[39.43±7.91)g/L](P<0.05)。经相关性检验,患者血清sICAM-1含量与TBIL、ALT和LPS均呈正相关(r=0.662,P<0.01;r=0.514,P<0.01和r=0.499,P<0.01),与ALB呈负相关(r=-0.423,P<0.01)。而IL-4与肝功能参数无相关性(P>0.05)。按Child-Pugh分级,随肝功能受损程度加重,患者血清sICAM-1、LPS、IL-6和TNF-α含量依次递增,Ⅲ级组与Ⅰ级组间差异有统计学意义(P<0.01)。结论华支睾吸虫病患者血清中sICAM-1、LPS、IL-6和TNF-α含量较高,共同参与介导了华支睾吸虫病肝损伤过程。

Objective To investigate the serum level of intercellular adhesion molecule-1 （ICAM-1） in patients with clonorehiasis, and the relationship between ICAM-1 and liver function. Methods Fifty untreated clonorchiasis patients and 20 normal controls were subjected in the present study. Plasma levels of total bilirubin （TBIL）, albumin （ALB） and alanine aminotransferasc （ALT） were determined by automatic biochemical analyzer. The patients were divided into three experiment groups （ I , Ⅱ, and Ⅲ） by Child-Pugh classification. Serum level of sICAM-I was determined by double-antibody sandwich ELISA. Radioimmunoassay was used to detect the content of interlenkin-4（IL-4）, interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） in serum. LAL tripeptide substrate staining quantitative method was used to detect the level of bacterial lipopolysaccharide （LPS） in plasma. Results The level of slCAM-1, LPS, IL-4, IL-6, TNF-α, TBIL, and ALT [（729.34±75.67） μg/ml, （0.18±.08） Eu/ml, （3.46＋0.38） ng/ml, （223.48±46.90） pg/ml, （1.39±0.62） ng/ml, （15.45±10.81） μmol/L, and （39.25±8.82）IU/L, respectively] in serum or plasma of clonorchiasis patients were significantly higher than that of the control group [（269.15±38.21） μg/ml, （0.07±.03） Eu/ml, （0.74±.22） ng/ml, （106.06±2.96） pg/ml, （0.56±.14） ng/ml, （6.31±.70）μmol/L, （18.43±9.81） IU/L] （P〈0.05 or P〈0.01）. Plasma level of ALB [（28.35±5.38） g/Ll was significantly lower than that of the control [（39.43±.91） g/L] （P〈0.05）. Correlation test showed that the sICAM-1 level in patients＇ sera was positively correlated with TBIL, ALT, and LPS （r=0.662, 0.514,0.499, P〈0.01）, while negatively correlated with ALB （r=-0.423, P〈0.01）. IL-4 level did not correlate with liver function parameters（P〉0.05）. According to the Child-Pugh classification, the more serious the liver function damaged, the higher level of slCAM-1, LPS, IL-6 and TNF-α in the experiment groups. Significant differences were found between groups Iil and I （P〈0.01）. Conclusion Higher serum levels of slCAM-1, LPS, IL-6, and TNF-α in patients with clonorchiasis take part in the process of liver injury induced by Clonorchis sinensis.