自身免疫性肝炎和原发性胆汁性肝硬化患者检测可溶性细胞间黏附分子1的临床价值

Clinical value of serum soluble intercellular adhesion molecule-1 in patients with primary biliary cirrhosis and autoimmune hepatitis

目的探讨原发性胆汁性肝硬化(PBC)和自身免疫性肝炎(AIH)患者中检测可溶性细胞间黏附分子1(sICAM-1)的临床价值。方法选择2012年6月-2013年9月住院及门诊就诊的PBC患者61例,其中初发患者29例,缓解期患者21例,复发患者11例;AIH患者共59例,其中初发患者26例,缓解期患者20例,复发患者13例。健康对照50例。血清sICAM-1测定方法为双抗体夹心酶联免疫吸附法,采用生物化学酶法测定血清ALT、TBil。各组间比较采用方差分析,相关性采用Pearson相关分析。结果PBC患者中,初发组和复发组sICAM-1水平均明显高于缓解组和对照组(P均=0.000);初发组和复发组之间sICAM-1水平差异无统计学意义(P=0.484);缓解组sICAM-1水平高于对照组(P=0.000);AIH患者中,初发组和复发组sICAM-1水平均明显高于缓解组和对照组(P均=0.000);初发组和复发组之间sICAM-1水平差异无统计学意义(P=0.802);缓解组和对照组之间sICAM-1水平差异无统计学意义(P=0.281);PBC、AIH患者血清sICAM-1与ALT呈正相关(r=0.664,P=0.000;r=0.784,P=0.000);PBC、AIH患者血清sICAM-1与TBil呈正相关(r=0.715,P=0.000;r=0.580,P=0.000)。结论 sICAM-1可能参与PBC、AIH的免疫损伤机制,PBC、AIH患者血清sICAM-1水平升高程度与肝损害严重程度有密切关系,临床上动态观察其血清水平的变化,可望在病情活动评估、判断预后、指导治疗中起重要作用。

Objective To investigate the clinical value of serum soluble intercellular adhesion molecule-1 （sICAM-1 ）in patients with primary biliary cirrhosis （PBC）and autoimmune hepatitis （AIH）.Methods Sixty-one PBC patients and 59 AIH patients,who were hospitalized or visited the outpatient department from June 2012 to September 2013,as well as 50 healthy controls,were included in the study. The PBC patients included 29 incipient cases,21 cases in remission,and 11 recurrent cases;the AIH patients included 26 incipient cases, 20 cases in remission,and 13 recurrent cases.Serum sICAM-1 level was measured by double-antibody sandwich enzyme-linked immunosorbent assay,and serum levels of alanine aminotransferase （ALT）and total bilirubin （TBil）were determined by biochemical enzyme as-say.Comparison between groups was made by analysis of variance;Pearson correlation analysis was performed.Results Among PBC pa-tients,the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group （P=0.000 for all）;there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group （P=0.484）;the remission group had a significantly higher serum sICAM-1 level than the control group （P=0.000）.Among AIH patients, the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group （P=0.000 for all）;there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group （P=0.802）;no significant difference in serum sICAM-1 level was seen between the remission group and control group （P=0.281）.For patients with PBC and AIH,serum sICAM-1 level was positively correlated with serum levels of ALT （r=0.664,P=0.000;r=0.784,P=0.000） and TBil （r=0.715,P=0.000;r=0.580,P=0.000）.Conclusion Serum sICAM-1 may be involved in the immunologic injury in PBC and AIH.In patients with PBC and AIH,the elevation of serum sICAM-1 level is closely correlated with the severity of liver damage. Clinical monitoring of serum sICAM-1 level may play an important role in severity assessment,prognostic evaluation,and therapy guidance among patients with autoimmune liver diseases.