乙型病毒性肝炎患者血清IL-2、sIL-2R和TNF-α的水平及其临床意义的研究

Studies of Serum Levels of IL-2,sIL-2R, and TNF-α and ITs Significance in Patients with Hepatitis B

目的：探讨各类型的乙型病毒性肝炎患者血清白细胞介素-Ⅱ（IL-2）、可溶性白细胞介素-Ⅱ受体（sIL-2R）和肿瘤坏死因子-α（TNF-α）水平的变化规律和临床意义，以及重症肝炎患者进行人工肝支持系统（ALSS）治疗后上述指标的变化规律。方法：应用酶联免疫吸附实验（ELISA）测试了126例标本，并结合乙型肝炎病毒e抗原（HBeAg）、乙肝病毒脱氧核糖核酸（HBV-DNA）、血清谷丙转氨酶（ALT）进行分析研究。结果：慢性乙肝和重症乙肝患者的血清IL-2水平明显低于急性乙肝患者和正常对照组（P＜0.01），急性乙肝、慢性乙肝和重症乙肝患者的sIL-2R、TNF-α水平显著高于正常对照组（P＜0.01），且重症肝炎组和其他肝炎组也存在显著差异（P＜0.01）。HBeAg阳性组sIL-2R水平高于HBeAg阴性组（P＜0.05），HBV-DNA阳性组sIL-2R、TNF-α水平高于HBV-DNA阴性组（P＜0.05，P＜0.01）。IL-2与sIL-2R、TNF-α呈负相关（P＜0.01，P＜0.05）；sIL-2R、TNF-α与ALT三者间呈正相关（P＜0.01）；在人工肝治疗24 h后，重症肝炎患者的血清IL-2水平回升，sIL-2R及TNF-α水平下降（P＜0.01），但在72 h后又有不同程度反弹。结论：乙肝患者血清IL-2、sIL-2R和TNF-α水平的不正常是由于乙肝?

Objectives: To investigate the clinical significance of the levels of IL-2, sIL-2R and TNF-α in serum in patients with various types of viral hepatitis B (VHB), and the changing regularity of the levels of those three indexes in patients with severe VHB following treatment with artificial liver supporting system (ALSS). Methods: The levels of IL-2, sIL-2R and TNF-α in serum in patients with VHB ( n =99) and controls ( n =27) were determined by ELISA. HBeAg, hepatitis B virus-DNA (HBV-DNA) and alanine aminotransferase (ALT) in patients with VHB were determined. Results: ①The level of IL-2 were significantly lower in patients with chronic and severe VHB than in patients with acute VHB and controls ( P ＜0.01). ②The levels of sIL-2R and TNF-αwere significantly higher in patients with VHB than in controls ( P ＜0.01). ③In patients with severe VHB, the levels of sIL-2R and TNF-α were higher and the level of IL-2 were lower than those in acute and chronic VHB( P ＜0.01). ④The level of sIL-2R were higher in patients with positive HBeAg than in patients with negative HBeAg ( P ＜0.05). ⑤The levels of sIL-2R and TNF-α were higher in patients with positive HBV-DNA than in patients with negative HBV-DNA ( P ＜0.05, P ＜0.01). ⑥The levels of sIL-2R and TNF-α correlated negatively with the level of IL-2 ( P ＜0.01, P ＜0.05), and correlated positively with the level of ALT ( P ＜0.01), respectively. ⑦In patients with severe VHB, the level of IL-2 increased ( P ＜0.01), while the levels of sIL-2R and TNF-α decreased ( P ＜0.01) 24h after treatment with ALSS. All of the above indexes resumed 72h after the treatment. Conclusions: ①The abnormal changes of the levels of IL-2, sIL-2R and TNF-α in serum in patients with VHB are due to the continuously expression of hepatitis B virus, and advancement of the state of VHB. ②The treatment by ALSS for patients with severe VHB could improve the immune function just for a short time.