慢性乙型肝炎患者血清细胞因子的检测及临床意义

The significance of serum cytokines combined determination in patients with chronic hepatitis B

目的探讨血清细胞因子(IL-10、IL-6、IL-18、IFN-γ)4个指标联合检测在慢性乙型肝炎(CHB)中的临床意义。方法采用ELISA法检测105例慢性乙型肝炎患者及30例健康者血清IL-10、IL-6、IL-18、IFN-γ水平,并采用RTPCR检测CHB患者的HBV-DNA,同时采用全自动生化分析仪检测CHB患者血清谷丙转氨酶(ALT)、谷草转氨酶(AST)和谷氨酰转肽酶(GGT)水平。结果 CHB患者除低病毒组IL-6水平与健康组比较差异无统计学意义(P>0.05),其余各病毒组的血清IL-6、IL-10、IL-18、IFN-γ水平均比健康组明显增高(P<0.01);且低、中、高病毒组之间血清各项指标两两比较,差异有统计学意义(P<0.01)。CHB患者血清IL-10、IL-6、IL-18水平与AST、ALT、GGT及HBV-DNA呈正相关(P<0.05或0.01);而IFN-γ与AST及HBV-DNA呈负相关(P<0.01),与ALT及GGT无明显相关性(P>0.05)。结论 CHB患者血清IL-10、IL-6、IL-18、IFN-γ的水平变化与其肝脏炎症程度、免疫应答异常及病毒复制密切相关,动态观察CHB患者血清细胞因子水平对CHB进展程度具有提示意义。

Objective To discuss the significance of combined serum cytokines（IL-10, IL-6, IL-18 and IFN-γ） determination in patients with chronic hepatitis B infection. Methods The serum level of IL-10, IL-6, IL-18 and IFN-γ was detected by using enzyme linked immunosorbent assay（ELISA） in 105 cases of CHB patients and 30 cases of healthy controls. The HBVDNA was detected by RT-PCR in CHB patients. At the same time, the serum levels of AST, ALT and GGT was detected by automatic biochemical analyzer in CHB patients. Results The serum level of IL-10, IL-18 and IFN-γ in CHB patients was significantly higher than those in healthy controls（P〈0.01）. The differences between serum levels of IL-10, IL-6, IL-18 and IFN-γ in low, medium and high virus groups are statistically significant between each two compared（P〈0.01）. With the levels of IFN-γ increased, HBV-DNA gradually reduced（P〈0.01）. While with the levels of IL-10, IL-6 and IL-18 increased, HBV- DNA gradually increased（P〈0.01）. The serum levels of IL-10, IL-6 and IL-18 were positively correlated with AST, ALT, GGT and HBV-DNA in CHB patients（P〈0.05∽0.01） whilst IFN-γ levels was negatively correlated with the AST and HBV-DNA（P〈0.01） but was no significant correlation with ALT and GGT（P〈0.05）. Conclusion The changes of serum level of IL-10, IL-6, IL-18 and IFN-γ was closely related with the degree of liver inflammation, abnormal immune response and viral replication in CHB patients. The dynamic observation of the serum levels of cytokines was prompt for CHB progress.