妊娠期戊型肝炎病毒感染患者NF-κB-p65表达水平

Expressions of NF-κB-p65 in pregnant women with HEV infection

目的分析外周血抗戊型肝炎病毒(HEV)IgM/IgG滴度、人核转录因子p50(NF-κB-p50)及人核转录因子p65(NF-κB-p65)表达水平与妊娠期感染HEV患者肝功能的相关性。方法选择河南科技大学第一附属医院收治的130例妊娠期感染HEV患者作为感染HEV组,并根据不同感染时期分为恢复期患者(n=48)和急性期患者(n=82),根据不同感染类型分为亚临床感染患者(n=41)和临床感染患者(n=89),另选取55例妊娠期健康孕妇作为未感染HEV组,比较各组抗HEV IgM/IgG滴度、NF-κB-p50、NF-κB-p65表达水平以及肝功能指标[丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBIL)]差异,分析四者与妊娠期感染HEV患者肝功能的相关性,利用受试者工作特征(ROC)曲线评价四者对妊娠期感染HEV的诊断价值。结果感染HEV组抗HEV IgM/IgG滴度、NF-κB-p50、ALT、AST及TBIL分别为(3.46±2.58)lg、(3.27±2.46)lg、(1.92±0.57)、(137.11±73.42)U/L、(128.28±75.25)U/L、(2.62±1.55)μmol/L高于未感染HEV组(P<0.05),NF-κB-p65(0.53±0.29)、ALB(2.93±0.84)g/dl明显低于未感染HEV组(P<0.05);急性期、临床感染患者抗HEV IgM/IgG滴度、NF-κB-p50、ALT、AST、TBIL高于恢复期患者、亚临床感染患者(P<0.05),NF-κB-p65、ALB低于恢复期患者、亚临床感染患者(P<0.05);Pearson相关性分析显示,抗HEV IgM/IgG滴度、NF-κB-p50均与ALT、AST、TBIL呈正相关(P<0.05),与ALB呈明显负相关(P<0.05);NF-κB-p65与ALT、AST、TBIL呈负相关(P<0.05),与ALB呈正相关(P<0.05);ROC诊断曲线结果显示,抗HEV IgM/IgG滴度诊断妊娠期感染HEV的敏感度分别为96.70%、97.20%,特异度分别为89.10%、89.10%,曲线下面积分别为0.956、0.958;NF-κB-p50及NF-κB-p65诊断妊娠期感染HEV的敏感度分别为85.00%、88.30%,特异度分别为90.90%、83.60%,曲线下面积分别为0.900、0.898,联合检测的曲线下面积为0.999,敏感度为98.60%,特异度为100.00%,均高于各项指标单一检测。结论外周血抗HEV IgM/IgG滴度、NF-κB-p50及NF-κB-p65表达水平与妊娠期感染HEV患者肝功能具有相关性,随抗HEV IgM/IgG滴度增加,NF-κB-p50表达上调及NF-κB-p65表达下调,患者肝功能损伤越严重,及时监测四者水平有助于预测妊娠期感染HEV,以尽早对可能出现肝功能损伤的患者进行干预。

OBJECTIVE To analyze the correlation between peripheral blood anti-hepatitis E virus(HEV)IgM/IgG titers,expression levels of human nuclear transcription factor p50(NF-κB-p50)and human nuclear transcription factor p65(NF-κB-p65)and liver function in patients with HEV infection during pregnancy.METHODS The 130 patients with HEV infection during pregnancy admitted to the First Affiliated Hospital of Henan University of Science and Technology were selected as HEV infection group,and were divided into convalescent phase patients(n=48)and acute phase patients(n=82)according to different infection periods,and were divided into subclinical infection patients(n=41)and clinical infection patients(n=89)according to different infection types.Another 55 healthy pregnant women during pregnancy were selected as HEV non-infection group.The anti-HEV IgM/IgG titers,expression levels of NF-κB-p50 and NF-κB-p65 and liver function index differences[alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),total bilirubin(TBIL)]were compared among groups,and the correlation between the four of them and liver function of patients with HEV infection during pregnancy was analyzed,and the receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of the four for HEV infection during pregnancy.RESULTS The anti-HEV IgM/IgG titers,NF-κB-p50,ALT,AST and TBIL of the HEV infection group were(3.46±2.58)lg10,(3.27±2.46)lg10,(1.92±0.57),(137.11±73.42)U/L,(128.28±75.25)U/L and(2.62±1.55)μmol/L,respectively,significantly higher than those in HEV non-infection group(P<0.05),while the NF-κB-p65(0.53±0.29 g/dl)and ALB(2.93±0.84)were significantly lower than those in HEV non-infection group(P<0.05).The anti-HEV IgM/IgG titers,NF-κB-p50,ALT,AST,and TBIL in acute phase and clinical infection patients were significantly higher than those in convalescent phase and subclinical infection patients(P<0.05),while the NF-κB-p65 and ALB were significantly lower than those in convalescent phase and subclinical infection patients(P<0.05).Pearson correlation analysis showed that anti-HEV IgM/IgG titers and NF-κB-p50 were significantly positively correlated with ALT,AST and TBIL(P<0.05),and significantly negatively correlated with ALB(P<0.05).NF-κB-p65 was significantly negatively correlated with ALT,AST and TBIL(P<0.05),and positively correlated with ALB(P<0.05).ROC diagnostic curve results showed that the sensitivities of anti-HEV IgM/IgG titers to diagnose HEV infection during pregnancy were 96.70%and 97.20%,and the specificities were 89.10%and 89.10%,and the areas under the curves were 0.956 and 0.958,respectively.The sensitivities of NF-κB-p50 and NF-κB-p65 to diagnose HEV infection during pregnancy were 85.00%and 88.30%,and the specificities were 90.90%and 83.60%,and the areas under the curves were 0.900 and 0.898,respectively.The area under the curve of the combined detection was 0.999,the sensitivity was 98.60%and the specificity was 100.00%,which were all higher than those of single detection of various indicators.CONCLUSION Peripheral blood anti-HEV IgM/IgG titers,expression levels of NF-κB-p50 and NF-κB-p65 were correlated with liver function of patients with HEV infection during pregnancy.With the increases of anti-HEV IgM/IgG titers,the expression of NF-κB-p50 was up-regulated,and the expression of NF-κB-p65 was down-regulation,the liver function damage was more severe among patients.Timely monitoring of the levels of the four can help predict HEV infection during pregnancy,so as to intervene as soon as possible for patients with possible liver function damage.