恩替卡韦对慢性乙型重型肝炎患者的炎症调节蛋白Tyro3的影响

Effect of Entecavir on Inflammatory Regulatory Protein Tyro3 in Patients with Chronic Severe Hepatitis B

目的探讨恩替卡韦对慢性乙型重型肝炎患者的炎症调节蛋白受体酪氨酸激酶Tyro3的影响。方法收集2012-01~2013-06汕头大学医学院第二附属医院感染科收治的29例慢性乙型重型肝炎患者的临床资料及血清标本,分成对照组10例及恩替卡韦组19例,其中恩替卡韦组予每日口服恩替卡韦0.5 mg。观察患者的生存率、血清生化学及病毒学等情况,并用ELISA方法检测治疗前与治疗4周后血清中炎症因子白介素6（IL-6）、干扰素α（IFN-α）、Tyro3的浓度并进行比较。结果恩替卡韦组患者4周生存率明显高于对照组（P=0.003）,血清总胆红素、凝血酶原时间、乙肝病毒载量均低于对照组,差异均有统计学意义（均P〈0.05）。恩替卡韦组患者治疗4周后血清IL-6浓度低于对照组（P=0.007）,Tyro3高于对照组（P=0.011）,差异有统计学意义,IFN-α浓度低于对照组,但差异无统计学意义（P=0.391）。结论恩替卡韦能提高慢性乙型重型肝炎患者的生存率,改善肝功能和抑制乙肝病毒复制,其作用机制可能与上调Tyro3的表达从而下调IL-6等炎症因子,减轻炎症反应,延缓肝细胞坏死有关。

Objective To explore the effect of entecavir on the inflammatory regulatory protein Tyro3 in patients with chronic severe hepatitis B. Methods Patients or their guardians decided whether to use entecavir after being told about the benefits and hazards. 29 patients were diagnosed as chronic severe hepatitis B hospitalized in the Department of Infectious Diseases in the Second Affiliated Hospital of Shantou University Medical College from January 2012 to June 2013. 10 patients were in the control group,and 19 patients were in entecavir group,who received oral entecavir 0. 5 mg every day. The primary outcomes were the survival,the recovery of biochemistry and the level of HBV DNA at 4-week. The second outcomes were the concentrations of interleukin 6（ IL-6）,interferon α（ IFN-α） and Tyro3 detected by ELISA and made the comparison between 2 groups. Results The 4 week survival rate of patients in entecavir group was significantly higher than that of the control group（ P = 0. 003）. The levels of total bilirubin,prothrombin time and HBV DNA were less than those in the control group（ P〈0. 05）. The level of IL-6 in entecavir group was less than that in the control group（ P = 0. 007）,while the level of Tyro3 was higher than that in the control group（ P = 0. 011）. Though the level of IFN-α was less than that in the control group,the difference was not significant（ P = 0. 391）. Conclusion Entecavir can remarkably improve the survival rate and liver function,and inhibit the replication of hepatitis virus B in patients with chronic severe hepatitis B,which may benefit from the up-regulating expression of Tyro3 which can down-regulate inflammatory factors,so the inflammatory response is relieved that delays the necrosis of liver cells.