血清白细胞介素-1受体拮抗剂与乙肝肝衰竭预后的相关性

Low serum interleukin-1 receptor antagonist level leads to poor outcomes in hepatitis B-related liver failure patients

目的白细胞介素-1受体拮抗剂(IL-1ra)是炎症细胞因子IL-1的天然拮抗剂,在许多炎症性疾病中发挥关键作用。本研究探讨IL-1ra在乙型肝炎相关肝衰竭(HB-ACLF)中的作用。方法采集31例HB-ACLF、28例急性乙型肝炎(AHB)、31例慢性乙型肝炎(CHB)患者及15例健康对照者(healthy controls,HC)外周静脉血,用QPlex法检测外周血IL-1ra、IL-1β、IL-6、IL-4、IL-10、TNF-α及IFN-γ浓度,并分析肝衰竭患者存活组与死亡组各细胞因子的差异。结果 HB-ACLF患者血清IL-1ra平均浓度为(338.9±268.8)pg/ml,与AHB[(182.7±123.1)pg/ml,P=0.012]、CHB[(77.07±40.5)pg/ml,P<0.001]及HC[(37.9±15.6)pg/ml,P<0.001]比较,浓度最高。但HB-ACLF患者IL-1ra/IL-1β比例(2.96±1.54)较AHB患者(4.54±2.29)低(P=0.048)。AHB患者血清IL-1ra浓度亦较CHB患者(P<0.001)及HC(P<0.001)高。在HB-ACLF患者中,最终死亡患者外周血IL-1ra浓度(P=0.02)及IL-1ra/IL-1β比值(P=0.007)均比存活者低。结论 IL-1ra在HB-ACLF发展过程中起重要作用,与HB-ACLF患者预后相关。

Objective To investigate the correlation of serum interleukin-1 receptor antagonist （IL-1RA） levels to outcomes of hepatitis B-related liver failure. Methods For the 31 hepatitis B-related acute-on-chronic liver failure patients, 28 acute hepatitis B patients ,30 chronic hepatitis B patients and 15 health controls, the serum IL-1ra and other six cytokines were measured by using Q-Plex. We further analyzed the concentrations of cytokines between death and survival HB- ACLF patients. Results The serum IL-1ra concentration was highest in patients with HB-ACLF[ （338.9 ± 268.8 ） pg/ ml ] when compared to those in AHB [ （ 182.7 ± 123.1 ） pg/ml, P = 0. 012 ], C HB [ （ 77.07±40.5 ） pg/ml, P 〈 0. 001 ] and HCs [ （37.9 ± 15.6）pg/ml,P 〈0. 001 ]. However, the ratio of IL-1ra to IL-1β in patients with HB-ACLF（2.96 ＋ 1.54） was lower than that in AHB patients（4.54 ±2.29） ,P =0. 048. Serum IL-lra in AHB patients was also higher than those in CHB（ P 〈 0. 001 ） and HCs（ P 〈 0. 001 ）. Both IL-1ra（ P = 0.02 ） and IL-1ra/IL-1 / （ P = 0. 007 ） were lower in No-survivors than Survivors in HB-ACLF patients. Conclusion 1L-1ra plays an important role in the development of HB- ACLF and is associated with outcome of HB-ACLF.