慢性乙型病毒性肝炎患者维生素D及其受体表达与炎症损伤程度及肝细胞癌发生的相关性分析

Correlation analysis of the expression of vitamin D and its receptor with the degree of in⁃flammatory damage and the occurrence of hepatocellular carcinoma in patients with chronic hepatitis B

目的探讨慢性乙型病毒性肝炎(CHB)患者维生素D(VitD)及其受体(VDR)表达与炎症损伤程度及肝细胞癌(HCC)发生的相关性。方法选取2018年6月至2020年6月沧州市传染病医院中西医结合肝病科102例CHB患者作为研究对象,根据其是否发生HCC分为HCC组20例、非HCC组82例。对比两组临床资料、VitD、VDR表达,分析CHB患者HCC发生影响因素及VitD、VDR表达与炎症损伤程度的关系,评价VitD、VDR表达对CHB患者HCC发生的预测价值。结果VDR在HCC患者癌组织及CHB患者肝脏组织中均表达,主要在细胞质表达,细胞核中基本无表达;两组年龄、吸烟、饮酒、HBVDNA、IL⁃6、Hs⁃CRP、TNF⁃α、VitD、VDR mRNA及蛋白表达相比,差异有统计学意义(P<0.05);Logistic回归分析显示,年龄、吸烟、饮酒、HBVDNA、IL⁃6、Hs⁃CRP、TNF⁃α、VitD、VDR mRNA及蛋白表达均为CHB患者HCC发生影响因素(P<0.05);Pearson相关性可知,CHB患者VitD表达与炎症损伤程度指标IL⁃6、Hs⁃CRP、TNF⁃α均呈负相关关系,VDR mRNA及蛋白表达与炎症损伤程度指标IL⁃6、Hs⁃CRP、TNF⁃α呈正相关关系(P<0.05);ROC曲线显示,VitD、VDR mRNA及蛋白表达联合预测HCC发生的AUC高于各指标单独预测,且>0.9,具有较高预测效能。结论CHB患者VitD与VDR表达与炎症损伤程度有关,且可能参与HCC发生发展过程,对HCC发生具有较高预测价值,为HCC防治提供一定理论依据。

Objective To explore the correlation between the expression of vitamin D(VitD)and its receptor(VDR)in patients with chronic viral hepatitis(CHB)and the degree of inflammatory damage and the occurrence of hepatocellular carcinoma(HCC).Methods A total of 102 CHB patients in our hospital from June 2018 to June 2020 were selected as the research objects.According to whether they had HCC,they were divided into 20 cases in the HCC group and 82 cases in the non⁃HCC group.The clinical data,the expres⁃sion of VitD and VDR between the two groups were compared,and the factors affecting the occurrence of HCC in CHB patients and the relationship between the expression of VitD and VDR and the degree of inflam⁃mation were analyzed.The predictive value of the expression of VitD and VDR on the occurrence of HCC in CHB patients was evaluated.Results VDR is expressed in both cancer tissues of HCC patients and liver tis⁃sues of CHB patients,mainly expressed in the cytoplasm,and no expression in the nucleus.The two groups of age,smoking,drinking,HBV DNA,IL⁃6,Hs⁃CRP,TNF⁃α,VitD,VDR mRNA and protein expression were significantly different(P<0.05).Logistic regression analysis showed that age,smoking,drinking,HBV DNA,IL⁃6,Hs⁃CRP,TNF⁃α,VitD,VDR mRNA and protein expression were all influential factors in the oc⁃currence of HCC in CHB patients(P<0.05).Pearson correlation shows that the expression of VitD in CHB pa⁃tients is negatively correlated with IL⁃6,Hs⁃CRP,and TNF⁃α,and the expression of VDR mRNA and protein is positively correlated with IL⁃6,Hs⁃CRP,and TNF⁃α,which are indicators of the degree of inflammation damage(P<0.05).The ROC curve shows that the combination of VitD and VDR mRNA and protein expres⁃sion predicts the occurrence of HCC in AUC higher than that of each indicator alone,and is>0.9,which has a higher predictive power.Conclusion The expression of VitD and VDR in CHB patients is related to the de⁃gree of inflammatory damage,and may participate in the occurrence and development of HCC.It has a high predictive value for the occurrence of HCC and provides a theoretical basis for HCC prevention and treatment.