人可溶性PD-1在肝病患者血清中表达检测及临床意义

Detection of soluble PD-1 in HBV^+ patients and its clinical significance

目的利用自主研发的可溶性PD-1(soluble PD-1,s PD-1)检测试剂盒,检测肝病患者外周血中s PD-1表达水平并分析其临床意义。方法 40例初诊HBV感染患者,其中单纯HBV+患者13例、合并肝硬化患者17例以及合并肝癌患者10例。同时收集16例性别年龄匹配的健康人作为对照组。利用自主研发的PD-1 ELISA试剂盒分析s PD-1表达水平,并结合临床资料分析s PD-1与临床参数的相关性以及在鉴别诊断中的价值。结果 HBV感染患者体内s PD-1水平显著高于健康对照组(P<0.05);单纯性HBV感染组、合并肝硬化组以及合并肝癌组s PD-1水平(μg·L-1)分别为4.755±1.554、0.940 2±0.231 9和0.766 5±0.349 1。各肝病患者组之间s PD-1水平存在显著性差异(P<0.01);且单纯HBV感染组s PD-1水平显著高于合并肝硬化(P<0.05)以及合并肝癌组(P<0.01);肝硬化组和肝癌组两者之间s PD-1水平不存在显著差异(P>0.05)。s PD-1水平与临床检验指标如T-BIL、D-BIL、I-BIL、AST以及ALT呈线性正相关,有统计学意义(P<0.05);s PD-1与ALP、TP、H-ALB、UREA、Cr-s以及UA未见显著相关性(P>0.05)。ROC曲线分析发现,s PD-1在对健康照组与单纯乙肝患者鉴别中具有显著差异(P=0.002)。结论 s PD-1在单纯HBV感染患者体内显著升高,并在疾病进程呈现动态变化。提示其在肝病进展中可能发挥着重要的调控作用。

To investigate the clinical significance of sPD-1 in HBV＋ patients with liver disease, 40 HBV＋ patients with liver disease, including 13 patients without other complication, 17 patients combined with liver cirrhosis, and 10 patients combined with liver cancer, were recruited, along with 16 healthy volunteer controls （HC）. Peripheral blood was collected from HBV＋ patients with liver disease and the levels of sPD-1 were measured with ELISA kit for sPD-1. We found the level of sPD-1 in HBV＋ patients with liver disease group was significantly higher than that in HC group （P 〈 0.05）. There was significant difference of sPD-1 levels among groups of patients with different liver diseases （P〈0.01）; and sPD-1 level in the hepatitis group was significantly higher than that in patients combined with hepatitis cirrhosis （P〈 0.05） and that in patients combined with liver cancer group （P〈 0.01）; no significant difference of sPD-1 levels was found between the cirrhosis and liver cancer group （P〉 0.05）. sPD-1 level was linear positive correlation with T-BIL, D-BIL, I-BIL, AST and ALT （P〈 0.05, respectively）. Additionally, the sensitivity and specificity of sPD-1 levels were examined through receiver operating characteristic （ROC） analysis to evaluate the value of sPD-1 in differential diagnosis of HBV＋ patients. On the basis of cutoff value, the sensitivity and specificity to distinguish HBV＋ patients without other complication vs HC were 69.23% and 81.25%. Taken together, sPD-1 increases significantly in patients with HBV infection, and presents dynamic changes in the disease process.