血清白细胞介素-37在乙型肝炎病毒相关慢加急性肝衰竭患者中的变化及其临床意义

Changes and clinical significance of serum IL-37 in patients with hepatitis B virus-related acute-on-chronic liver failure

目的探讨血清白细胞介素-37(IL-37)在乙型肝炎病毒相关的慢加急性肝衰竭(HBV-ACLF)患者中的变化特点及其临床意义。方法选择2015年6月—2017年6月我科收治的HBV-ACLF的患者81例(HBV-ACLB组),其中早期25例、中期32例、晚期24例。同时纳入同期住院的慢性乙型肝炎患者30例(CHB组)和健康体检者30例(健康对照组)。比较3组患者血清IL-37和肝功能指标的差异,分析HBV-ACLF患者血清IL-37水平与肝功能指标及患者预后的关系。结果HBV-ACLF组血清IL-37水平显著高于CHB组和健康对照组(P<0.05)。HBV-ACLF患者晚期组血清IL-37水平显著高于中期组和早期组(P<0.05),中期组显著高于早期组(P<0.05)。HBV-ACLF患者血清IL-37水平与丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)水平呈正相关(rs分别为0.52、0.72)。随访2个月,共22例患者发生感染,39例死亡;感染患者和死亡患者血清IL-37水平分别高于非感染患者和存活患者(P<0.05)。结论HBV-ACLF患者血清IL-37水平与患者病情严重程度有关,可在一定程度上反映患者的预后。

Objective To investigate the expression of interleukin-37 (IL-37) in patients with hepatitis B virusrelated acute-on-chronic liver failure (HBV-ACLF) and its clinical significances. Methods Eighty-one patients with HBV-ACLF admitted to our hospital from June 2015 to June 2017 were enrolled as study subjects (HBV-ACLB group), and 30 patients with chronic hepatitis B (CHB) were used as CHB group and 30 healthy people with physical examination were used as control group. In HBV-ACLB group there were 25 patients at early stage, 32 cases at middle stage and 24 cases at advanced stage at admission. Markers of liver function and serum levels of IL-37 were compared between three groups of patients. Pearson or Spearman correlation analysis were used to analyze the correlation between IL-37 level and markers of liver function, and the prognosis of HBV-ACLF. Results There was significantly higher serum level of IL-37 in HBVACLF group than that of CHB and control groups (P<0.05). Among the patients with HBV-ACLF, those in the advanced stage had significantly higher levels of IL-37 than those in the patients with middle stage and early stage, and those in the middle stage had significantly higher levels of IL-37 than those in the early stage (P<0.05). There were positive correlation between IL-37, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in HBV-ACLF group (rs values were 0.52 and 0.72, respectively). Among 81 cases of HBV-ACLF, 22 cases acquired infection and 39 cases died during the 2- month follow-up period. The serum levels of IL-37 were significantly higher in the infected cases and death cases than those in the non-infected cases and survival cases (P<0.05). Conclusion The serum level of IL-37 is associated with the severity of HBV-ACLF, and which can be used as an important prognostic marker for ACLF.