HBV相关肝硬化重叠戊型肝炎病毒感染患者临床特征及血清IL-22水平研究

Clinical characteristics of patients with HBV-related cirrhosis overlapping hepatitis E virus infection and level of serum IL-22

目的探究肝硬化重叠戊型肝炎病毒(HEV)感染患者的肝功能指标特征及血清白介素22(IL-22)等相关细胞因子水平,分析IL-22在判断疾病严重程度中的价值。方法选取2010年5月-2015年5月于医院就诊的96例急性戊型肝炎病毒(HEV)感染患者为研究对象,根据是否有乙型肝炎病毒(HBV)相关肝硬化分为重叠感染组57例和单纯感染组39例,另选取医院体检的30例健康志愿者为对照组,10例无急性HEV感染的代偿期肝硬化患者为空白组;测定受检者血清丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)、总胆红素(TBIL)、白蛋白(ALB)、白细胞(WBC)、血小板(PLT)、肌酐(Cr)及凝血酶原活动度(PTA)水平,采用酶联免疫吸附法测定IL-22、白介素17(IL-17)、白介素6(IL-6)和肿瘤坏死因子α(TNF-α)、干扰素-γ(IFN-γ)等水平,比较不同组别间各指标的差异。结果重叠感染组ALT、AST、TBIL值显著高于单纯感染组(P<0.05),ALB、PTA、PLT等反应凝血功能的指标显著低于单纯感染组(P<0.05);重叠感染患者的IL-22水平显著高于单纯感染和空白患者(P<0.05);IL-17、TNF-α水平重叠感染组>空白组>单纯感染组(P<0.05);血清IFN-γ水平各组比较差异无统计学意义。结论 HBV相关肝硬化状态下重叠感染HEV可导致更严重的肝损伤,IL-22参与HEV感染后肝脏炎性损伤的过程。

OBJECTIVE To explore the characteristics of liver function indexes and levels of related cytokines such as serum IL-22 in patients with cirrhosis overlapping hepatitis E virus（HEV）infection and observe the value of serum IL-22 in judgment of severity of disease.METHODS A total of 96 patients with acute HEV infection who were treated in the hospital from May 2010 to May 2015 were recruited as the study objects and divided into the superinfection infection group with 57 cases and the single infection group with 39 cases according to the status of HBV-related cirrhosis,meanwhile,30 healthy volunteers who received the physical examination were assigned as the control group,and 10 decompensated cirrhosis patients without acute HEV infection were set as the blank group.The levels of serum alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TBIL）,albumin（ALB）,white blood cell（WBC）,platelet（PLT）,creatinine（Cr）,and prothrombin activity（PTA）of the subjects were determined;the levels of cytokines such as IL-22,IL-17,IL-6,TNF-α,and IFN-γwere determined by means of enzyme-linked immunosorbent assay;the indexes were observed and compared among the groups.RESULTS The levels of ALT,AST,and TBIL of the superinfection group were significantly higher than those of the single infection group（P〈0.05）.The levels of coagulation function indicators such as ALB,PTA,and PLT of the superinfection group were significantly lower than those of the single infection group（P〈0.05）.The IL-22 level of the patients with superinfection was significantly higher than that of the patients with single infection and the patients in the blank group（P〈0.05）.The levels of IL-17 and TNF-αof the superinfection group were higher than those of the blank group,the levels of IL-17 and TNF-αof the blank group were higher than those of the single infection group（P〈0.05）.There was no significant difference in the level of serum IFN-γamong the groups.CONCLUSION The HBVrelated cirrhosis complicated with HEV superinfection may result in more severe liver injury,and the IL-22 may involve in the process of the hepatic inflammatory injury after the HEV infection.